Scapholunate Dislocation

Aka: Scapholunate Dislocation, Scapholunate Dissociation, Scapholunate Ligament Rupture, Scapholunate Tear, Complete Scapholunate Ligament Rupture, Scapholunate advanced collapse, SLAC Wrist

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II. Mechanism

  1. Fall on Outstretched Hand
  2. Scapholunate interosseous ligament is disrupted resulting in instability

III. Symptoms

  1. Radial aspect Wrist Pain, worse with gripping

IV. Imaging

  1. Wrist XRay
    1. Scaphoid Bone and Lunate Bones separated 3 mm or more (aka Terry Thomas Sign, David Letterman Sign)
  2. Clenched-Fist View
    1. Accentuates widening between the Scaphoid Bone and the Lunate Bone

V. Differential Diagnosis

  1. Scaphoid Fracture
  2. Distal Radius Fracture

VI. Associated Conditions

  1. Median Nerve injury
  2. Lunate Avascular Necrosis

VII. Management

  1. Immobilization in short arm volar splint
  2. Refer to orthopedics or orthopedic hand specialist
  3. Surgical repair
    1. Indicated for static dissociations
    2. Dynamic dissociations may be treated with 2-6 weeks of Forearm cast

VIII. Complications

  1. Scapholunate advanced collapse (SLAC Wrist)

IX. References

  1. Eiff (2018) Fracture Management, Elsevier, Philadelphia, p. 99-101
  2. Swadron and Mallon in Herbert (2018) EM:Rap 18(12): 3-4

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