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Question
45 year-old right-hand dominant patient presents with right hand pain from a prior injury to hand. Patient has also been injecting subcutaneous heroin into hand for relief. What's the diagnosis?
Answer
Perilunate dislocation (volar displacement)...and severe hand cellulitis.
Perilunate and Lunate dislocations
- Lunate dislocation: normal alignment of the distal radius, carpels, and metacarpals; the lunate is displaced
- Perilunate dislocation: lunate will demonstrate normal alignment and the remainder of the carpels and metacarpals will typically be displaced in a dorsal direction (occasionally in a volar direction as in this case)
- These dislocations occur following high-energy trauma, typically with a hyperextended and ulnar deviated hand
- Plain films are usually enough to make diagnosis, but CT may be used to assess for associated occult fractures (e.g., diagnose co-existing scaphoid fracture
References
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