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short arm thumb spica cast
2%
120/6499
long arm thumb spica cast
1%
35/6499
urgent closed reduction and splinting
95%
6180/6499
MR arthrogram of the wrist to assess ligamentous injuries
128/6499
bone scan to assess vascularity
0%
9/6499
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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.
4.1
(33)
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