Classification and management of carpal dislocations

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Radiology

Background:

• Carpal dislocations are complex wrist injuries.
• Perilunate and lunate dislocations represent stages of the same injury spectrum.
• Accurate diagnosis and management are critical for functional recovery.

Purpose of the Study:

• To present a classification and management plan for carpal dislocations.
• To emphasize the importance of anatomic reduction of key carpal elements.
• To highlight specific considerations for perilunate, lunate, and transscaphoid perilunate dislocations.

Main Methods:

• Classification based on injury patterns and displacement (dorsal/volar).
• Emphasis on closed reduction followed by assessment for rotary scaphoid subluxation and intercalary instability.
• Surgical intervention (open reduction and internal fixation) indicated for failed closed reduction or instability.

Main Results:

• Anatomic restoration of the scaphoid, lunate, and capitate is essential.
• Rotary subluxation of the scaphoid requires specific correction in certain dislocations.
• Transscaphoid perilunate dislocations necessitate stable reduction of the scaphoid fracture to prevent complications.
• Combined dorsal and volar surgical approaches are recommended for dislocations.

Conclusions:

• Carpal dislocations require a systematic approach to management.
• Early diagnosis and intervention are paramount for successful treatment.
• Specific attention to scaphoid integrity and stability is vital in managing complex carpal injuries.