Journal of Postgraduate Medicine, Education and Research

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VOLUME 52 , ISSUE 4 ( October-December, 2018 ) > List of Articles

CASE REPORT

Volar Perilunate Dislocation with Acute Median Nerve Compression: A Case Study and Literature Review

Saurabh Singh, Sanjay Yadav, Rajkumar Arya, Divyansh Sharma

Keywords : Dislocation, Median nerve, Perilunate,Compression

Citation Information : Singh S, Yadav S, Arya R, Sharma D. Volar Perilunate Dislocation with Acute Median Nerve Compression: A Case Study and Literature Review. J Postgrad Med Edu Res 2018; 52 (4):187-189.

DOI: 10.5005/jp-journals-10028-1300

License: CC BY-ND 4.0

Published Online: 00-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Perilunate dislocations, lunate dislocations, and perilunate fracture-dislocations are rare injuries (< 10% of all wrist injuries). Volar lunate dislocations are severe carpal injuries occurring after high-energy trauma to a wrist and fall on outstretched hyperextended hand. Case study: We present a case of a 35-year male who developed paraesthesia in the distribution of median nerve after injury. On examination, there was the prominence of lunate on the volar aspect of the hand. Wrist dorsiflexion was 30°, volar flexion 45°, radial deviation 10°, and ulnar deviation 20°. A full range of pronation and supination was possible. The sensation was reduced in the distribution of the median nerve. No thenar, hypothenar or intrinsic muscle wasting was present. Plain radiograph and CT scan revealed volar lunate dislocation. Management and results: Manual reduction was tried in an emergency under sedation. Then the patient was shifted to the operating room for open reduction and stabilization. The volar approach was used. Carpal tunnel release was done simultaneously. Lunate was reduced and stabilized with scapholunate and lunotriquetral K-wires. Scapholunate ligament was repaired. Above elbow, slab support was given postoperatively. Sutures were removed two weeks after surgery. Slab support was removed after four weeks. Wrist splint was given for further four weeks. Gentle wrist physiotherapy was started. At final follow-up, wrist dorsiflexion was 45°, palmar-flexion was 70°, the ulnar deviation was 30°, and the radial deviation was 20°. Conclusion: Volar lunate injuries are uncommon. Compression of the median nerve can occur due to a volar displacement of lunate. These injuries need to be identified and treated appropriately for better outcomes.


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