The mechanism of ulnar-sided perilunate instability of the wrist: A cadaveric study and 6 clinical cases

Peter M. Murray, Christopher G. Palmer, Alexander Y. Shin

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: To define the mechanism of ulnar-sided perilunate instability using a cadaveric model and correlate these biomechanical findings with 6 clinical cases. Methods: We mounted 16 fresh-frozen human cadaver arms and loaded them to failure in extension and radial deviation, recreating our understanding of the injury mechanism leading to ulnar-sided perilunate instability of the wrist. After testing, we examined the wrists clinically and radiographically. We identified, examined, and treated 6 patients with ulnar-sided perilunate instability over a period of 5 years. Based on these data, we propose a 3-stage mechanism for ulnar-sided perilunate instability of the wrist. Results: In 13 of 16 specimens, we observed failure of ulnotriquetral, ulnolunate, and ulnocapitate ligaments as well as the dorsal scaphotriquetral and dorsal radiotriquetral ligaments. In 11 of these 13, the lunotriquetral interosseous ligament was disrupted, and in 2 of the 11, a dorsal perilunate dislocation occurred. After comparing these laboratory findings with clinical findings in 6 patients with ulnar-sided perilunate instability, we propose the following 3-stage mechanism for ulnar-sided perilunate instability: stage 1, disruption of the lunotriquetral interosseous ligament; stage 2, stage 1 plus disruption of the ulnolunate, ulnotriquetral, and ulnocapitate ligaments as well as the dorsal scaphotriquetral and radiotriquetral ligaments; and stage 3, stage 2 with progression of the injury through the midcarpal joint plus disruption of the scapholunate and radioscapholunate ligaments, potentially resulting in a dorsal perilunate dislocation. Conclusions: We describe a 3-stage mechanism of ulnar-sided perilunate ligamentous wrist injury that can lead to dorsal perilunate dislocation. We recommend considering ulnar-sided perilunate instability of the wrist in patients with ulnar wrist pain after a fall on the outstretched wrist. Clinical relevance: Ulnar-sided wrist injury can lead to subtle forms of perilunate instability.

Original languageEnglish (US)
Pages (from-to)721-728
Number of pages8
JournalJournal of Hand Surgery
Volume37
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Wrist
Ligaments
Wrist Injuries
Wounds and Injuries
Clinical Studies
Cadaver
Arm
Joints
Pain

Keywords

  • cadaver
  • instability
  • perilunar
  • radiograph
  • Ulnar
  • wrist

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

The mechanism of ulnar-sided perilunate instability of the wrist : A cadaveric study and 6 clinical cases. / Murray, Peter M.; Palmer, Christopher G.; Shin, Alexander Y.

In: Journal of Hand Surgery, Vol. 37, No. 4, 04.2012, p. 721-728.

Research output: Contribution to journalArticle

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