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Perilunate and Lunate Dislocations

By Danielle Campagne, MD

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Patient Education

A perilunate dislocation is disruption of the normal relationship between the lunate and capitate. A lunate dislocation is separation of the lunate from both the capitate and the radius.

Perilunate and lunate dislocations result when great force is applied to a hyperextended wrist. They usually result from a fall on an outstretched hand or occur in a motor vehicle crash. Perilunate dislocations are 5 times more common than lunate dislocations.

These dislocations cause pain, swelling, and deformity in the wrist and proximal hand.

If a perilunate or lunate dislocation is not diagnosed and treated promptly, complications can develop. They include

  • Median nerve injury

  • Avascular necrosis of the scaphoid or lunate and deterioration of the joint (scapholunate advanced collapse).

Diagnosis

  • X-rays

Plain x-rays (anteroposterior, lateral, and oblique views) are taken. To avoid missing the diagnosis, clinicians should assess the relationship between the radius, lunate, and capitate bones on a true lateral view.

In a perilunate dislocation, the capitate is not vertically aligned with the lunate and radius on a lateral view of the wrist. The lunate and radius remain correctly aligned.

In a lunate dislocation, the lunate is rotated out of alignment into a spilled teacup configuration.

Treatment

  • Closed reduction and splinting

  • Usually surgical repair

Treatment of both perilunate and lunate dislocations is closed reduction and splinting in the emergency department. Both the wrist and elbow should be immobilized in the neutral position (eg, with a sugar-tong splint).

Patients should be immediately referred to an orthopedic surgeon; most dislocations must be surgically repaired because function is better after surgical repair.

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* This is the Professional Version. *