Virani Siddharth R, Wajekar Sagar, Mohan Hariharan, Dahapute Aditya A
Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
J Clin Orthop Trauma. 2016 Oct-Dec;7(Suppl 1):110-114. doi: 10.1016/j.jcot.2016.04.003. Epub 2016 May 6.
Perilunate dislocations are commonly seen after fall on an outstretched hand in extremes of dorsiflexion and ulnar deviation. A greater arc injury is one when there is an associated fracture of one or more bones around the lunate while a lesser arc injury is associated with pure ligamentous disruption around the lunate.
We report a unique case of bilateral trans-scaphoid perilunate dislocation in a 35-year-old male labourer. This is the first reported case where the lunate dislocated into the forearm on the volar aspect. Urgent open reduction and stabilization of both wrists was done. Currently, the wrist is stable with functional range of motion with union of both scaphoid fractures at 1-year follow-up.
A delay in management of perilunate dislocations is associated with unfavourable prognosis. Prompt reduction and fixation is of paramount importance. Radiocarpal arthritis is associated with delayed management. In our case, the patient has regained painless functional range of motion without any radiological evidence of arthritis.
We thus conclude that all perilunate dislocations must undergo emergency reduction. Open reduction and ligamentous repair should be considered as the treatment of choice as it is associated with better functional outcomes in terms of pain and arthritis.
月骨周围脱位常见于手掌极度背伸和尺侧偏斜时手部伸展位着地后。当月骨周围有一块或多块骨头发生骨折时，称为大弧损伤；而小弧损伤则仅与月骨周围的单纯韧带断裂有关。
我们报告一例35岁男性劳工双侧经舟骨月骨周围脱位的独特病例。这是首例报告的月骨掌侧脱位至前臂的病例。对双腕进行了紧急切开复位和内固定。目前，随访1年时，腕关节稳定，活动范围正常，舟骨骨折均已愈合。
月骨周围脱位治疗延迟与预后不良相关。及时复位和固定至关重要。桡腕关节炎与治疗延迟有关。在我们的病例中，患者恢复了无痛的正常活动范围，且无任何关节炎的影像学证据。
因此，我们得出结论，所有月骨周围脱位均须紧急复位。切开复位和韧带修复应被视为首选治疗方法，因为就疼痛和关节炎而言，其功能预后更佳。
