MANUAL MINORS
Wrist dislocations occur when one or more of the carpal bones shift out of their normal alignment with the radius and ulna or with other carpal bones. The most common dislocation is of the lunate, though other carpal bones can also become dislocated. These injuries are typically caused by high-energy trauma, such as falls onto an outstretched hand or sports accidents.
Diagnosis
The diagnosis is based on:
Severe wrist pain, with swelling and visible deformity, especially if significant displacement is present.
Severe limitation of wrist and hand movement.
X-rays reveal the displacement of the carpal bones, particularly the lunate. CT scans or MRIs may be needed to better assess ligament damage and the relationship between the carpal bones.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Distal Radius Fracture | Pain and deformity in the wrist, with a fracture visible at the distal radius on X-ray. |
Barton’s Fracture-Dislocation | Displacement of the distal radius fragment with a visible fracture on X-ray. |
Wrist Sprain | Pain without evidence of dislocation or fracture on X-rays. |
Scaphoid Fracture | Pain in the anatomical snuffbox with a scaphoid fracture, but no evident dislocation. |
Emergency Management
Immediate immobilisation of the wrist with a splint to stabilise the joint and prevent further displacement.
Application of ice to reduce swelling and administration of analgesics or anti-inflammatory drugs for pain control.
Initial X-rays to confirm the dislocation and assess the type of displacement.
In some cases, closed reduction under sedation or local anaesthesia may be attempted to restore the normal alignment of the bones, although many dislocations require surgical intervention.
Definitive Treatment
The treatment depends on the type and severity of the dislocation:
Closed reduction: Can be performed in simple, stable dislocations under anaesthesia, followed by immobilisation in a cast or splint for 4-6 weeks.
Surgical treatment: In complex dislocations or those with significant instability, open reduction with internal fixation using screws or pins is required to realign the bones and repair damaged ligaments.
After treatment, rehabilitation is crucial to restore wrist mobility, strength, and function. Complications include stiffness, chronic instability, or persistent pain if the dislocation is not properly corrected.
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