Diagnosis of perilunate dislocation in the Emergency Department

Periluntae dislocation as well as other perilunate injuries are significant disorders of the wrist usually caused by high energy falls, and are associated with a high incidence of chronic pain and disability. A case is presented of a 27 year old footballer with a complicated perilunate fracture dislocation. The mechanisms involved in this injury are discussed, as well as the appropriate clinical and radiological examination of these patients to reduce the risk of a missed perilunate injury.

When a wrist injury is not a Colles' Fracture - abstract

Fractures of the lower radius with anterior displacement of the distal fragment are very uncommon injuries. These injuries, designated Smiths' and Barton's Fractures, tend to be readily confused with and misdiagnosed as the commoner Colles' fracture in which the distal fragment is displaced posteriorly, producing the well-known clinical "Dinner Fork Deformity". Between January 1977 and October 1984, 12 fractures of the distal radius with anterior displacement were seen and treated at the Queen Elizabeth Hospital. The case notes and radiographs of these 12 patients were studied, and nine were available for interview and examination. The injuries arose from falls (5), cycle accidents (6), and blows to the back of the hand (1). Two fractures were in children. In ten of the 12 cases the initial diagnosis was incorrect. On average presentation was late, 3 to 4 days, with one patient presenting one month after injury. Most fractures were treated by open reduction and fixation; three, including two children, were treated by manipulation and Plaster-of-Paris (AU)