If you are unsure, it is best to err on the safe side and call for help. A 35-year-old professional football player complains of severe wrist pain after making a tackle. Volar wrist swelling is usually prominent. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. Recent radiographs are seen in Figure B. Surgical treatment that will best address his symptoms and preserve wrist motion consists of, Anterior and posterior interosseous neurectomy. He sustained 2 minor falls over the next 6 years and his wrist pain recurred. 43 (1): 84-92. After completing instrumentation, radiocarpal screw penetration is best assessed on which fluoroscopic view? Ulnar side of hand. Scaphoid Lunate Advanced Collapse (S-LAC) - Hand - Orthobullets Scapholunate ligament - Wikipedia positive test seen in patients with scaphol-unate ligament injury or patients with liga-mentous laxity, where the scaphoid is no longer constrained proximally and sublux-ates out of the scaphoid fossa resulting in pain; when pressure removed from the The lunate is made up of the volar pole, body, and dorsal pole. (SLAC) - Hand - Orthobullets Scapholunate Advanced Collapse Article - StatPearls Scapholunate advanced collapse (SLAC) of the wrist is a very common case of degenerative arthritis . A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. Data Trace Publishing Company Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. Incompetence of which of the following anatomic structures is the most likely etiology of this finding? (OBQ10.127) 110 West Rd., Suite 227 Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. The black dot in the photo is the capitate. (OBQ05.25) Scapho-lunate advanced collapse arthritis or SLAC occurs as the result of unrecognised injury to the . Unable to process the form. Thank you. A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. When the lunate is severely fracture, collapsed, or arthritic, salvage treatments such as lunate and other wrist bone removal may be necessary. Which of the following fluoroscopic views is used to assess intra-articular screw penetration during volar fixation of a distal radius fracture? Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate. The latter mechanism frequently occurs . Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. . Perilunate fracture-dislocations of the wrist, Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate, Orthopaedic Specialists of North Carolina. Given the lunate's position in the wrist, there is significant overlap from other carpal bones and hence these fractures can be subtle. (OBQ13.78) She was seen in the emergency department at the time of injury and was told she had a sprain. Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner. Hook of hamate fractures are rare, often missed, injuries generally as a result of a direct blow to the hamate bone most commonly seen in athletes. Immediate post-operative radiographs are seen in Figure A. Medical Information Search Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-80825, see full revision history and disclosures, Mayfield classification of carpal instability, dorsal intercalated segment instability (DISI), volar intercalated segment instability (VISI), scaphoid nonunion advanced collapse (SNAC), triangular fibrocartilaginous complex (TFCC) injuries, ulnar-sided wrist impaction and impingement syndromes, calcium pyrophosphate dihydrate deposition disease. scaphoid is flexed and lunate is extended as scapholunate ligament no longer restrains this articulation, lunate extended > 10 degrees past neutral, resultant scaphoid flexion and lunate extension creates, abnormal distribution of forces across midcarpal and radiocarpal joints, malalignment of concentric joint surfaces, describes predictable progression of degenerative changes from the radial styloid to the entire scaphoid facet and finally to the unstable capitolunate joint, as the capitate subluxates dorsally on the lunate, key finding is that the radiolunate joint is spared, unlike other forms of wrist arthritis, since there remains a concentric articulation between the lunate and the spheroid lunate fossa of the distal radius, Arthritis between scaphoid and radial styloid, Arthritis between scaphoid and entire scaphoid facet of the radius, While original Watson classification describes preservation of radiolunate joint in all stages of SLAC wrist, subsequent description by other surgeons of "stage IV" pancarpal arthritis observed in rare cases where radiolunate joint is affected, validity of "stage IV" changes in SLAC wrist remains controversial and presence pancarpal arthritis should alert the clinician of a different etiology of wrist arthritis, patients localize pain in region of scapholunate interval, tenderness directly over scapholunate ligament dorsally, will not be positive in more advanced cases as arthritic changes stabilize the scaphoid, with firm pressure over the palmar tuberosity of the scaphoid, wrist is moved from ulnar to radial deviation, positive test seen in patients with scapholunate ligament injury or patients with ligamentous laxity, where the scaphoid is no longer constrained proximally and subluxates out of the scaphoid fossa resulting in pain, when pressure removed from the scaphoid, the scaphoid relocates back into the scaphoid fossa, and typical snapping or clicking occurs, obtain standard PA and lateral radiographs, PA radiograph will reveal greater than 3mm diastasis between the scaphoid and lunate, PA radiograph shows sclerosis and joint space narrowing between scaphoid and the entire scaphoid fossa of distal radius, PA radiograph shows sclerosis and joint space narrowing between the lunate and capitate, and the capitate will eventually migrate proximally into the space created by the scapholunate dissociation, thinning of articular surfaces of the proximal scaphoid, scaphoid facet of distal radius and capitatolunate joint with synovitis in radiocarpal and midcarpal joints, NSAIDs, wrist splinting, and possible corticosteroid injections, prevents impingement between proximal scaphoid and radial styloid, may be performed open or arthroscopically via 1,2 portal for instrumentation, since posterior and anterior interosseous nerve only provide proprioception and sensation to wrist capsule at their most distal branches, they can be safely dennervated to provide pain relief, can be used in combination with below procedures for Stage II or III, contraindicated with caputolunate arthritis (Stage III SLAC) because capitate articulates with lunate fossa of the distal radius, contraindicated if there is an incompetent radioscaphocapitate ligament, excising entire proximal row of carpal bones (scaphoid, lunate and triquetrum) while preserving, provides relative preservation of strength and motion, also provides relative preservation of strength and motion, wrist motion occurs through the preserved articulation between lunate and distal radius (lunate fossa), similar long term clinical results between scaphoid excision/ four corner fusion and proximal row carpectomy, wrist fusion gives best pain relief and good grip strength at the cost of wrist motion, - Scaphoid Lunate Advanced Collapse (SLAC), Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). This medication is given in an effort to decrease the incidence of which of the following? The most important differential is of other carpal dislocations, particularly: In addition to stating that a lunate dislocation is present, a number of features should be sought and commented upon: ensure that radiolunate alignment is disrupted, and that you are not looking at a perilunate dislocation(stage II carpal dislocation), evaluate and comment on the degree or palmar rotation of the lunate (this can be up to 270 degrees)4, ensure that the capitate remains co-linear with the long axis of the radius, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Capitate fractures account for 1-2% of all carpal fractures 1,2. The swelling often causes a decrease in 2-point discrimination in the median nerve distribution due to acute carpal tunnel syndrome. Colles'. What complication is most likely to occur in this patient? The rest of the carpal bones are in a normal anatomic position in relation to the radius. You can rate this topic again in 12 months. (OBQ04.38) Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. What is the most appropriate treatment at this time? Which of the following radiographic views shown in Figures A to E would be most helpful in establishing the diagnosis? Perilunate instability represents about 7 percent of all injuries to the carpus [ 5 ]. Radiographs are provided in Figure A. Orthopaedic Specialists of North Carolina. A 56-year-old male presents to your clinic with a 4-month history of inability to extend the IP joint of his thumb. Stage IV denotes a true lunate dislocation, involving a . Mayfield JK, Johnson RP, Kilcoyne RK. Pearls/pitfalls. Inability to flex the index finger proximal interphalangeal joint. Lunate fracture. Which plating option provides the most appropriate treatment of this fracture? Adequate maintenance of reduction by non-operative treatment is unsuccesful. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline.