Frane Nicholas, Goldenberg William
Northwell Health at Hofstra School of Medicine Department of Orthopaedic Surgery
Perilunate dislocations (PLDs), lunate dislocations (LDs), and perilunate fracture-dislocations (PLFDs) are rare high-energy injuries constituting less than 10% of all wrist injuries. The carpus consists of two rows of bones: proximal and distal. The proximal row, which is the more mobile of the two, articulates with the distal radius and moves in concert with the distal radius and ulna. The scaphoid, lunate, and triquetrum serve as the connecting bones that make up the proximal row. The more rigid distal row—which contains the trapezium, trapezoid, capitate, and hamate serves as a bridge between the proximal row and metacarpal bases. The carpus’ stability is maintained through its bony articulations and intrinsic and extrinsic ligaments. As its name suggests, the lunate is a semilunar bone with a crescent shape. Its proximal end is convex and articulates with the concave lunate facet of the distal radius. The distal articular surface is concave and articulates with the capitate. Bordered by the scaphoid radially and the triquetrum to its ulnar border, the lunate is attached to the scaphoid and triquetrum by the intrinsic scapholunate and lunotriquetral ligaments, respectively. Palmar attachments include the radiolunotriquetral, radioscapholunate, and ulnolunate extrinsic ligaments. The lunate serves as a center keystone and link between the forearm and the hand. In general, PLDs occur through injuries to the surrounding stabilizing structures, such as through fractures and disruptions in articulations or ligaments. The surrounding carpal bones most commonly dislocate dorsally, and the lunate maintains its articulated position with the distal radius. Alternatively, albeit rarely, the lunate can dislocate in the volar direction into the space of Poirier. Because these injuries have the potential to cause lifelong disability of the wrist, early recognition and diagnosis are prudent to restore patient function and prevent morbidity. Early treatment may prevent or lessen the chance of median neuropathy, post-traumatic wrist arthrosis, chronic instability, and fracture nonunion. Nonoperative treatment is rarely indicated and is associated with poor functional outcomes and recurrent dislocation.
月骨周围脱位（PLD）、月骨脱位（LD）和月骨周围骨折脱位（PLFD）是罕见的高能损伤，占所有腕部损伤的比例不到10%。腕骨由两排骨头组成：近端和远端。近端排是两排中活动度较大的一排，与桡骨远端关节相连，并与桡骨远端和尺骨协同运动。舟骨、月骨和三角骨是构成近端排的连接骨。较为坚硬的远端排包含大多角骨、小多角骨、头状骨和钩骨，作为近端排和掌骨基底之间的桥梁。腕骨的稳定性通过其骨连接以及内在和外在韧带得以维持。顾名思义，月骨是一块呈新月形的半月形骨头。其近端呈凸形，与桡骨远端的凹形月骨关节面相关节。远端关节面呈凹形，与头状骨相关节。月骨的桡侧以舟骨为界，尺侧以三角骨为界，分别通过内在的舟月韧带和月三角韧带与舟骨和三角骨相连。掌侧附着结构包括桡月三角韧带、桡舟月韧带和尺月外在韧带。月骨是前臂与手部之间的中心关键骨和连接部位。一般来说，月骨周围脱位是由周围稳定结构的损伤引起的，例如关节或韧带的骨折和断裂。周围的腕骨最常向背侧脱位，而月骨与桡骨远端保持其关节连接位置。或者，尽管很少见，月骨也可能向掌侧脱位进入普瓦捷间隙。由于这些损伤有可能导致腕部终身残疾，因此早期识别和诊断对于恢复患者功能和预防发病至关重要。早期治疗可能预防或减少正中神经病变、创伤后腕关节病、慢性不稳定和骨折不愈合的发生几率。非手术治疗很少被采用，且与功能预后不良和复发性脱位相关。
