Question

45 year-old right-hand dominant patient presents with right hand pain from a prior injury to hand. Patient has also been injecting subcutaneous heroin into hand for relief. What's the diagnosis?

 

Answer

Perilunate dislocation (volar displacement)...and severe hand cellulitis.

Perilunate and Lunate dislocations

• Lunate dislocation: normal alignment of the distal radius, carpels, and metacarpals; the lunate is displaced 
• Perilunate dislocation: lunate will demonstrate normal alignment and the remainder of the carpels and metacarpals will typically be displaced in a dorsal direction (occasionally in a volar direction as in this case)
• These dislocations occur following high-energy trauma, typically with a hyperextended and ulnar deviated hand
• Plain films are usually enough to make diagnosis, but CT may be used to assess for associated occult fractures (e.g., diagnose co-existing scaphoid fracture

 

References

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