Diagnosis and management of acute fracture-dislocation of the carpus

Perilunate dislocations and fracture-dislocations of the carpus are devastating injuries. To minimize morbidity, an early and accurate diagnosis is essential. Although an early closed reduction is recommended, understanding wrist kinematics has allowed clinicians to realize that anatomic open reduction, internal fixation, and ligamentous repair are vital for optimal functional results. This repair is achieved best using a combined volar and dorsal approach. Outcome is correlated with the magnitude of the initial trauma and accuracy of the reduction. Associated injuries in the axial fracture-dislocations usually dictate the outcome. Repair of these associated injuries and anatomic reduction and fixation of fracture-dislocations are important for excellent results.