Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK.
Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK.
Br J Hosp Med (Lond). 2021 Jul 2;82(7):1-10. doi: 10.12968/hmed.2021.0025. Epub 2021 Jul 13.
Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.
月骨脱位是一种不常见但严重的腕部损伤，通常由高能创伤机制引起。应遵循先进的创伤生命支持方案来诊断和治疗危及生命的并发病理。需要彻底检查神经血管和软组织，以识别开放性伤口和正中神经功能障碍，包括急性腕管综合征。影像学检查用于评估损伤严重程度，根据梅菲尔德分类进行分级。急诊科进行闭合复位是初始治疗方法，可减轻对神经血管结构的压力。确定性治疗是手术，最常见的方法是通过切开复位和直接韧带稳定。手术的目的是恢复腕骨的解剖排列并保持稳定性，从而修复和愈合重要的腕部韧带。中至长期的功能结果是足够的，大多数患者在 6 个月内恢复工作。然而，中腕关节炎的进行性放射学进展以及握力、活动范围和慢性疼痛的永久性丧失较为常见。本文讨论了急性月骨和月骨周围脱位的解剖、诊断和治疗。
