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Perilunate – Injury, Symptoms and Treatment

Perilunate refers to injuries occurring around the lunate bone in the wrist. These serious injuries are usually caused by high-energy trauma and require prompt diagnosis and treatment.

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Things worth knowing about "Perilunate"

Perilunate refers to injuries occurring around the lunate bone in the wrist. These serious injuries are usually caused by high-energy trauma and require prompt diagnosis and treatment.

What Does Perilunate Mean?

The term perilunate derives from Latin and means around the lunate bone. The lunate bone is one of the eight small carpal bones and plays a central role in the stability and mobility of the wrist. Perilunate injuries affect the structures surrounding this bone – including ligaments, adjacent bones, or both.

Causes

Perilunate injuries are typically caused by high-energy trauma, such as:

Fall onto an outstretched hand (a classic injury mechanism)
Motor vehicle accidents
Sports injuries (e.g., horse riding, motorcycling, or rock climbing)
Occupational accidents involving strong force applied to the wrist

The injury force is usually transmitted through a combination of wrist dorsiflexion (bending backward), ulnar deviation (movement toward the little finger side), and axial compression.

Types of Perilunate Injuries

Perilunate Dislocation

In a perilunate dislocation, the surrounding carpal bones are displaced from their normal position relative to the lunate, while the lunate itself remains in its anatomical position relative to the radius (forearm bone). This is a rare but serious injury.

Lunate Dislocation

In a lunate dislocation, the lunate bone itself is displaced from its normal position – it typically rotates toward the palm (palmarly). This is considered an advanced stage of perilunate injury.

Perilunate Fracture-Dislocation

Bone fractures frequently accompany the ligament injury. The most well-known form is the trans-scaphoid perilunate dislocation, in which the scaphoid bone fractures alongside the dislocation.

Symptoms

Typical symptoms of perilunate injuries include:

Severe wrist pain, especially on the back of the wrist
Significant swelling and bruising (hematoma)
Reduced or absent wrist mobility
Visible wrist deformity (in cases of dislocation)
Numbness or tingling in the fingers (due to pressure on the median nerve within the carpal tunnel)

Diagnosis

Diagnosis is made through several steps:

Clinical Examination

The physician examines the wrist for swelling, tenderness, restricted movement, and neurological deficits.

Imaging

X-ray: Standard views in two planes (anteroposterior and lateral). The lateral view typically reveals the characteristic malalignment in perilunate dislocation.
CT scan (Computed Tomography): Used to accurately assess bone fractures and the spatial relationship between the carpal bones.
MRI (Magnetic Resonance Imaging): Used to evaluate ligament injuries not visible on X-ray.

Treatment

Emergency Management

Perilunate dislocations are considered orthopaedic emergencies. Prompt reduction (realignment) is necessary to relieve pressure on nerves and blood vessels. In the emergency department, a closed reduction under anaesthesia is usually attempted first.

Surgical Treatment

In most cases, surgery is required to permanently stabilise the carpal bones. Surgical steps may include:

Reconstruction or repair of torn ligaments
Fixation of bones using screws or Kirschner wires
Bone grafting in cases involving fractures

Post-operative Rehabilitation

Following surgery, a period of immobilisation in a cast or splint for several weeks is typically required, followed by targeted physiotherapy and occupational therapy to restore strength and range of motion. Recovery may take several months.

Possible Complications

Carpal tunnel syndrome due to ongoing pressure on the median nerve
Avascular necrosis of the lunate (bone death due to disrupted blood supply)
Post-traumatic arthritis of the wrist
Chronic wrist instability
Reduced grip strength and hand function

References

Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS (eds.) – Green's Operative Hand Surgery, 7th edition. Elsevier, 2017.
Mayfield JK, Johnson RP, Kilcoyne RK – Carpal dislocations: pathomechanics and progressive perilunar instability. Journal of Hand Surgery, 1980; 5(3): 226–241.
American Society for Surgery of the Hand (ASSH) – Clinical guidelines on wrist injuries and carpal instability. Available at: www.assh.org

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