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Related Experiment Video

Updated: Sep 25, 2025

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Reverse Perilunate Injuries-The "Extended Scaphoid" Sign.

Guillaume Herzberg1, Marion Burnier2, Thibault Druel1

  • 1Department of Orthopedics, TRues Wrist Surgery Unit, Clinique Parc Lyon, Lyon, France.

Journal of Wrist Surgery
|April 28, 2022
PubMed
Summary

Reverse perilunate injuries (REPLI) are rare, distinct from classic perilunate injuries (PLI). This study identifies an extended scaphoid position on initial radiographs as a key indicator of REPLI.

Keywords:
carpusperilunate injuriesreverse perilunate dislocationwrist

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Hand Surgery

Background:

  • Reverse perilunate injuries (REPLI) are uncommon variants of classic perilunate injuries (PLI).
  • Classic radial-sided dorsal PLI typically show a flexed scaphoid on initial radiographs.
  • An extended scaphoid position on initial radiographs was hypothesized to indicate REPLI.

Purpose of the Study:

  • To investigate the association between an extended scaphoid position on initial radiographs and reverse perilunate injuries (REPLI).
  • To differentiate the radiographic patterns of REPLI from classic perilunate injuries (PLI).

Main Methods:

  • Review of initial posteroanterior (PA) and lateral emergency radiographs from a specialized wrist surgery series of 114 dorsal pure ligamentous PLI.
  • Analysis of available radiographic figures from the REPLI literature.
  • Comparison of scaphoid positioning and associated carpal instabilities between REPLI and classic PLI.

Main Results:

  • Seven cases within the PLI series exhibited an extended scaphoid position; 107 showed a flexed position.
  • Radiographs in the REPLI literature consistently displayed an extended scaphoid, lunotriquetral dissociation, and dorsal capitate dislocation relative to the lunate.
  • The classic dorsal PLI pattern showed a flexed, foreshortened scaphoid with a scapholunate gap.

Conclusions:

  • The study confirms that an extended scaphoid position on initial radiographs is indicative of REPLI.
  • Dorsal REPLI patterns feature an extended scaphoid with scapholunate step-off/overlap, contrasting with the scapholunate gap in classic PLI.
  • A combination of lunotriquetral dissociation, dorsal capitate dislocation, and an extended scaphoid strongly suggests REPLI.