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Title: Lunate Dislocation

Category: Orthopedics

Keywords: Lunate, Dislocation, Perilunate (PubMed Search)

Posted: 3/21/2009 by Michael Bond, MD (Updated: 7/21/2026)

Lunate Dislocation and perilunate dislocation are broken down into 4 stages that relates to the progressive disruption of the carpal ligaments due to hyperextension and ulnar deviation of the wrist:

  • Stage 1: Scapholunate Dislocation
    • Has the characteristic sign of widening of the scapholunate joint on the PA view known as the Terry Thomas Sign as it resembles the gap between his teeth
    • Gap between scaphoid and lunate should be less than 2 mm
  • Stage II: Perilunate dislocation
    • Best seen on lateral view of the wrist
    • Associated with scaphoid fractures
    • Lunate stays in its normal position with the capitate dislocation posterior when you use the distal radius as your reference point
  • Stage III: Perilunate dislocation
    • Also includes dislocation or fracture of the triguetrum
    • Triquetrial and scaphoid malrotation
    • In lateral view, all other carpal bones are dislocated posterior with respect to lunate
  • Stage IV:  Lunate dislocation
    • On PA view you will see a triangular view of the lunate on the PA view that looks like a "piece of pie". 
    • On the lateral view of the wrist the lunate will look like a tea cup tipped in the volar direction AKA the "spilled teacup sign"
    • Associated with a scaphoid fracture
       

For a good indepth review of lunate and perilunate injuries please read the article by Andy Perron with this attached link.... doi:10.1053/ajem.2001.21306   

If you are interested in seeing some xray examples please visit LearningRadiology.com

 

References

Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic Pitfalls in the ED: Lunate and Perilunate Injuries Am J Emerg Med 2001;19:157-162


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