MANUAL MINORS
Carpal dislocations involve the abnormal displacement of one or more of the bones that make up the carpus (wrist), usually as a result of trauma. These injuries can affect one or several bones and, while uncommon, are serious as they are often associated with damage to ligaments and neurovascular structures. The most common types are perilunate dislocation, scaphoid dislocation, and capitate dislocation.
Diagnosis
The diagnosis is based on clinical evaluation, with the patient presenting with severe pain, visible deformity, swelling, and difficulty or inability to move the wrist. X-rays are essential to identify the type of dislocation, while MRI or CT scans may help assess ligament injuries or associated fractures.
Differential Diagnosis
Condition | Key Characteristics |
|---|---|
Scaphoid Fracture | Pain in the anatomical snuffbox, without visible dislocation on X-rays. |
Distal Radius Fracture | “Dinner fork” deformity, affecting the forearm more than the wrist. |
De Quervain’s Tenosynovitis | Localised pain on the radial side of the wrist, without evident trauma or deformity. |
Median Nerve Injury | Paraesthesia and weakness in the nerve’s distribution, without evidence of dislocation. |
Emergency Management
In emergencies, management includes rapid immobilisation of the affected wrist with a splint or bandage, pain control with analgesics, and closed reduction under sedation if possible.
It is crucial to assess the neurovascular status to rule out compression of the median nerve or surrounding arteries. In complicated dislocations, immediate open reduction may be necessary.
Definitive Treatment
Definitive treatment depends on the type and severity of the dislocation. Surgical intervention is often required to stabilise the carpal joints, repair ligaments, and in some cases, fix the bones with pins or screws. Physiotherapy is an integral part of recovery to restore wrist mobility and function.
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