Perilunate injuries: diagnosis and treatment

Perilunate injuries are severe disruptions of the carpus, which present a formidable challenge to the treating physician. Accurate recognition of the pattern of injury is not always straightforward. The injury can propagate through ligaments and/or bone, creating multiple variations of a basic injury pattern. Posteroanterior and lateral radiographs will depict a perilunate injury, but additional views may be necessary to appreciate subtle carpal fractures. Once the diagnosis has been established, early intervention is necessary for optimal results. An initial closed reduction with sedation and traction is performed to restore overall carpal alignment. However, subsequent closed or open reduction is necessary to restore anatomic alignment of all injured structures. The outcome of perilunate injuries correlates with the adequacy of reduction. Complications such as chondrolysis, carpal instability, and traumatic arthritis can occur despite satisfactory treatment.