Musculoskeletal case studies for medical students
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A 48 yr. male fell off a roof onto his outstretched right hand.
He also suffered a extracapsular fracture of his Right hip.
The lunate is seen dislocated on the lateral x ray (previous page), while the
rest of the wrist bones are in normal position. On the AP x ray, the lunate
appears triangular and overlaps the adjacent carpal bones. The reason for the
tingling sensation in the hand is median nerve compression. This nerve is in
danger with a dislocation of the lunate.
The lunate needs to be reduced as an emergency. A closed reduction was achieved
by dorsiflexing the wrist and gentle pressure on the lunate. The volar ligaments
still need a repair. An open procedure was scheduled three days later for repair
of these ligaments. If the expertise is available, the open repair can be done
under the same general anaesthetic. Because of the danger of carpal tunnel syndrome
these dislocations need an emergency reduction. Sometimes a carpal tunnel release
may be required as an emergency. If your hospital is far from help attempt the
closed reduction . After reduction, refer all lunate dislocations to an experienced
Orthopaedic surgeon as the ruptured carpal ligaments may need repair, even after
a successful closed reduction.