Case Report: Complete Radiocarpal Dislocation Case Introduction A 32 year old male presents to the emergency department (ED) via ambulance after an approximately 80 mph helmeted motorcycle crash (MCC).
Case Report: Complete Radiocarpal Dislocation Case A 32 year old male presents to the emergency department (ED) via ambulance after an approximately 80 mph helmeted motorcycle crash (MCC). His chief complaint is pain in his left arm and left shoulder. After evaluating for other injuries, you identify a left wrist deformity with exposed bone.
His sensorimotor exam is notable for reduced sensation along the left 5th digit. Subsequent radiographs identify trans-scaphoid perilunate dislocation , with resulting complete radiocarpal dislocation. Initial radiograph showing complete radiocarpal dislocation.
Posterior-anterior radiograph immediately following reduction and splinting in the trauma bay. Procedure: Perilunate and Wrist Dislocation Reduction All perilunate dislocations must be reduced in the ED as soon as possible. This must be done to reverse median nerve compression at the carpal tunnel, as well as to decompress the vasculature supplying the displaced carpal bones. After appropriate analgesia and/or anesthesia, the operator should apply uninterrupted finger trap traction with the patient’s elbow flexed 90° for 10-15 minutes.
Once the muscles of the hand are fatigued, the following methodology of closed reduction can be performed. While maintaining longitudinal traction during the entire procedure, the patient’s wrist is extended using one hand, while the thumb of the other hand stabilizes the lunate by pushing dorsally on the palmar surface of the wrist. Gradual wrist flexion allows the capitate to relocate into the concavity of the lunate.
If you are experiencing symptoms that may be related to wrist dislocation following a motorcycle crash, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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