Lunate and Perilunate Dislocations: Tips and Tricks for Problem Fractures

Perilunate injuries represent a spectrum of insult to the carpus leading to progressive carpal instability. These injuries are most frequently associated with high-energy mechanisms and their diagnoses can be missed. Lunate and perilunate injuries may be purely ligamentous or involve fractures and dislocations of the carpal bones, most commonly the scaphoid (trans-scaphoid perilunate injury). This can be attributed to the complex interplay of the ligamentous and bony architecture of the wrist and resultant biomechanics. Accurate diagnosis relies on a thorough history and physical exam as well as scrutiny of adequate and quality radiographs.