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Mentions: A 25-year-old man, an apprentice welder in a heavy steel industry, was returning home after watching a late-night movie show. When he was walking alone, before he realized two robbers followed and stopped him for money. Then the two robbers one on each side twisted his arms toward his back. They held his forearms in neutral and elbows in 90° flexion. His wrists were forced in full volar flexion, radial deviation, and pronation. The situation was simulated in the diagram [Figure 1a]. While he was struggling to free himself, both the intruders were forcibly pronating his hands with the wrists kept in full volar flexion. He cried loudly because of severe shooting pain in hands and wrists. The intruders escaped from the scene shortly. His hands and wrists were swollen and very painful. Radiographs were obtained on the next day, and it revealed dorsal perilunate dislocation of both wrists [Figure 1b and c]. Avulsion fractures of the posterior horn of the lunates, radial translation of the carpal bones and fracture of the tips of ulnar styloid processes were noticed [Figure 2a and b]. The patient was treated by closed reduction under general anesthesia. Gentle traction was applied to the hand in slight volar flexion over the steadily held forearm in neutral position on both sides. The wrists, with traction on, were gently deviated radially and pronated. Then, the hands were supinated with continued traction while pushing the dorsally displaced carpi volarward. The dislocations got reduced without much difficulty [Figure 3]. A well-padded, below-elbow POP back slab was applied, keeping the wrist in 15°-20° volar flexion and 20°-25° ulnar deviation on both sides. After four weeks of immobilization, active exercises were started. The wrists regained almost full range of movements in about 10 weeks time. The patient was lost to further follow-up.
Bilateral dorsal perilunate dislocation of wrist
Bottom Line: The wrists were suddenly and forcibly pronated.Radial translation of the carpal bones was also noted.The mechanism is proposed and discussed.
Affiliation: Department of Orthopaedics, Osmania Medical College, Hyderabad - 500 001, India.
We present a case of simultaneous dorsal perilunate dislocation of both wrists, without a history of fall on outstretched hands. In contrast, it appeared that the mechanism was reverse. His hands were held in radial deviation with wrists in full palmar flexion. The forearms were in neutral position and elbows in mid-flexion. The wrists were suddenly and forcibly pronated. The radiographs of both wrists showed dorsal perilunate dislocation with avulsion fracture of the tip of ulnar styloid process and avulsion fracture of posterior horn of lunate. Radial translation of the carpal bones was also noted. The mechanism is proposed and discussed.