Lunate and perilunate dislocations
Introduction
Introduction to lumbar dislocation and dislocation around the lunate Lumbar dislocation refers to the displacement of the lunate bone itself from the normal adjacent relationship between the tibia and other carpal bones. The dislocation around the lunate bone refers to the normal relationship between the lunate bone and the tibia, and the other carpal bones around it are dislocated; the scaphoid and lunate bone Dislocation around is a scaphoid fracture. The relationship between the proximal end of the fracture and the lunate bone and the tibia is normal, and the distal end and other carpal bones are dislocated. basic knowledge The proportion of illness: car accident and other trauma can directly lead to the disease, the incidence rate is about 0.04% -0.07% Susceptible people: no special people Mode of infection: non-infectious Complications: fracture
Cause
Lumbar dislocation and the cause of dislocation around the lumbar bone
Causes:
Mostly caused by indirect violence. Indirect violence is the effect of violence on the body, and the force is transmitted to the injured part through the limb to cause fracture. The fracture is mostly simple and stable, and most of them are not displaced.
Pathogenesis:
1. Lumbar dislocation: Most of the lumbar dislocation is the extreme dorsiflexion of the wrist during the fall. The lunate bone is caused by the head bone and the tibia. The lumbar bone is surrounded by the articular surface. The ligaments in the dorsal ligament of the lunar canal and the ligament of the palpebral palpebral ligament, when the ligament of one side is broken, if it can be restored early, the status quo can be maintained, and the ligament is not reset or the ligaments on both sides are broken.
2. Dislocation around the lunate bone: the dislocation around the lumbar bone is mostly when the palm is on the ground when the fall, the wrist is stretched back, the violence acts on the metacarpal and distal carpal bones, the intercarpal ligament and the joint capsule are ruptured, the lunate bone remains in place, other The carpal bone is dislocated to the dorsal and proximal side of the lunate bone.
3. Dislocation around the scaphoid bone: its pathogenesis is similar to dislocation around the lunate bone, but with a scaphoid fracture, the proximal end of the fracture is normal with the lunate bone and the tibia, and the distal end is accompanied by dislocation of the other carpal bone.
Prevention
Lumbar dislocation and prevention of dislocation around the lunate
Usually pay attention to diet problems, do not eat some foods that are not good for the disease, and add more vitamins and protein nutrients. It is better to arrange a diet rich in vitamins and calcium. Increase the sunshine time, if the winter sunshine is insufficient, you can properly add vitamin D or cod liver oil to promote calcium absorption.
Complication
Lumbar dislocation and complications of dislocation around the lunate Complications
Can be complicated by median nerve injury and flexor tendon rupture.
Symptom
Lumbar dislocation and symptoms of dislocation around the lumbar bone Common symptoms Joint pain joint swelling Carpal dysplasia...
The wrist often has a clear history of back extension and trauma, such as walking with the palm of the hand when walking down, joint pain, swelling and tenderness range is larger than a single carpal fracture, but the late stage can also be confined to a smaller area, the range of motion and grip strength are obvious Decreased, the volar dislocation of the tibia can increase the tension of the flexor tendon, the finger is semi-buckled, the pain is exacerbated when passively stretching or actively flexing the finger, the volar side of the wrist is full, and the palpation can feel the object under the skin protuberance, the tibia of the lunate Dislocation can increase the internal pressure of the carpal tunnel, causing the median nerve to be compressed, and the three sides of the temporal side are abnormal. The old dislocation sometimes causes the spontaneous fracture of the flexor tendon.
The dislocation around the lunate bone is mostly dislocation, and often accompanied by carpal or sacral fractures, distal ulnar fractures, such as scaphoid fractures, head bone fractures, etc., and scaphoid fractures, said a dislocation around the scaphoid bone fracture or Dislocation around the scaphoid bone, to indicate that the extent of injury is different from the simple dislocation around the lunate bone. If the fracture occurs in other bones, the name of the diagnosis can be deduced, such as the dislocation of the skull around the skull. Triangular bone fractures and dislocations around the lunate bone, fractures and dislocations around the periosteum of the humerus, if multiple fractures, the names of the affected bones may be arranged in turn, such as dislocation around the lunate bone of the scaphoid and cephalic bone fractures. The bone is deformed by a dislocation around the skull of the skull.
Lumbar dislocation has two forms of volar and dorsal dislocation, the latter is rare.
Obvious history of trauma, swelling of the wrist after injury, pain, deformity, X-ray and CT examination can help diagnose.
Examine
Lumbar dislocation and examination of dislocation around the lunate
No relevant laboratory tests.
The dislocation around the lunate bone, the X-ray anterior slice shows the interruption of the wrist bone arc, the head bone and the lunate bone, the humerus and the scapula projection overlap, the wrist joint space disappears, the scaphoid interosseous joint gap widens, the lumbar bone around the lumbar bone And , the distal end of the ulna may have a fracture, the X-ray lateral slice can be seen that the scaphoid flexion is enlarged, the longitudinal axis is nearly perpendicular to the longitudinal axis of the humerus, and the proximal pole is located at the dorsal or volar side of the distal humerus. The relationship between the bone and the distal end of the humerus was normal, there was no obvious abnormality in the joint space of the lunar joint, and the remaining carpal bone was dislocated to the dorsal or volar side.
Among them, the head bone is the most prominent, the head is released from the distal concave surface of the lunate bone, and is located on the dorsal or volar side of the lunate bone. If there is a fracture of the wrist bone around the lunate bone, the distal segment is more off to the dorsal or volar side, and the proximal side. The segment remains in place, maintains a normal relationship with the lunate bone, active or passive active wrist joints, sometimes can hear bone rubbing, closed reduction failure, the dorsal dislocation around the lunate bone can sometimes be converted into lumbar volar dislocation, That is, before the reduction, the dorsal dislocation around the lunate bone, after the failure of the reduction, it becomes the dislocation of the tibia of the lunate bone; or the coexistence of the two, the dislocation of the dorsal side of the lunate bone is not corrected, but the palmar bone is more flexed, and the lumbar joint is back. The lateral gap was widened, showing the dislocation of the volar side of the lunate bone. The reduction was too rough and the ligament of the dorsal ligament of the wrist was torn.
Lumbar dislocation, X-ray anterior slice can be seen from the trapezoidal shape to the triangle shape, the surrounding joint space is not parallel or wide and narrow, the lateral position sees the volar side of the lumbar dislocation, the light, the lunate bone is still located in the concave surface of the distal radius Excessive palmar flexion, the dorsal space of the lunar joint is widened, and the head bone is opposite to the dorsal aspect of the lunate bone. In severe cases, the lumbar flexion of the lunate bone is greater than 90° into the carpal tunnel, and the distal end of the humerus and the head bone are completely separated.
Although the X-ray images of lumbar dislocation and lumbar dislocation are significant, the rate of missed diagnosis is still high. I am afraid that the X-ray lateral image overlaps with each other. The outline of a single carpal bone is difficult to distinguish. If the diagnosis is difficult, CT can be done. an examination.
Diagnosis
Diagnosis and differentiation of lumbar dislocation and dislocation around the lunate
Lumbar dislocation, X-ray anterior slice shows that the contour of the lunate bone changes from trapezoid to triangle, and the joint joints are not parallel or wide. Lateral position, see the volar dislocation of the lumbar bone. In the light, the lunate bone is still located in the concave surface of the distal radius of the humerus, and the palmar flexion is excessive. The posterior space of the lunar joint is widened, and the head bone is opposite to the dorsal side of the lunate bone. In severe cases, the lumbar flexor is more than 90° into the carpal tunnel, completely separated from the distal radius and the head bone.
