Musculoskeletal case studies for medical students

View Table: Case Selection  

Back to List 


A 48 yr. male fell off a roof onto his outstretched right hand.

He also suffered a extracapsular fracture of his Right hip.

He had a tingling sensation in the lateral side of his right hand.
Initial X ray
Description Lateral X ray
X ray
Description AP X ray
Problem The 48 year old man who fell on his outstretched hand. What is your diagnosis. Read how this was treated, and why.
X ray after treatment
Description Lateral X ray after reduction
Post management further view
Description After reduction

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.

Discussion of management

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.


 Copyright 2011, University of Stellenbosch