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A 35-year-old professional football player complains of severe wrist pain after making a tackle. He reports paresthesias in his thumb and index finger. AP and lateral radiographs of the wrist are shown in figures A and B respectively. What is the most appropriate next step in management?
short arm thumb spica cast
long arm thumb spica cast
urgent closed reduction and splinting
MR arthrogram of the wrist to assess ligamentous injuries
bone scan to assess vascularity
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This patient is presenting with a perilunate dislocation with carpal tunnel symptoms. The most important next step in treatment is reduction of the dislocation. This is generally performed in the emergency room, and if unsuccessful, immediate reduction and stabilization in the operating room is indicated.
Kozin et al note that these injuries can be overlooked and have variable propagation patterns through the carpus/carpal ligaments. This patient has a radial styloid fracture due to avulsion of the radiocarpal ligaments.
Melone et al note that these injuries were historically treated with closed reduction and pinning, but more recently the trend is for open reduction and fixation, for optimal anatomic restoration.
Figure A is an AP radiograph that shows obvious scapholunate diastasis due to a perilunate dislocation. Figure B shows the 'empty teacup' sign due to the empty articulation of the distal lunate.
Melone CP, Murphy MS, Raskin KB
Hand Clin. 2000 Aug;16(3):439-48. PMID: 10955217 (Link to Abstract)
J Am Acad Orthop Surg. 1998 Mar-Apr;6(2):114-20. PMID: 9682074 (Link to Abstract)
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HPI - Motorcycle accident 16 weeks ago
How would you treat this chronic lunate dislocation/injury?
HPI - Patient fell with the bike. No other complaints. Immediate closed reduction in ER.
How would you treat this injury?
HPI - accidental trauma, fell from ladder
how would you have treated this?