Bilateral anterior glenohumeral dislocation in a weight lifter

A case of bilateral anterior dislocation of the shoulder joint is described. The patient was a recreational weight lifter who sustained the injury while performing the 'pull-over' bench movement using free weights. Probably, the shoulders dislocated when the force developed by the periarticular muscles was less than the actual weight that the patient was trying to lift. The need for stricter safety rules and better supervision in health clubs is stressed.     

Palmar lunate dislocation

Palmar lunate dislocation as the end stage of a perilunate dislocation is a very uncommon injury.Having treated 19,534 hospitalized patients between 1 January 1986 and 1 October 2001 the diagnosis was recorded in four male trauma patients (33, 36, 37 and 62 years old).Among the operatively treated carpal dislocations and carpal fracture dislocations those of the lunate were seen in five per cent.The dislocation was caused in by an acute hyperextension injury resulting of falls from heights in three cases, and of a motorcycle accident in a further case. In two of these cases a complete palmar lunate dislocation was analysed that were produced by fall from seven meters heights of a young craftsman and by accident of a motorcyclist.First using a longitudinal palmar approach in both cases a revision of the hemorrhagic carpal canal was performed urgently, the largely denuded lunate was reduced and the repair of identified ligamentous structures was performed by means of sutures respectively suture anchors.Reduction was stabilized with Kirschner wires. Afterwards performed computed tomography identified the result of reduction and associated defects (subluxation distal radioulnar joint). In one patient a soft tissue infection prevented the dorsal ligamentous repair. In spite of a consequent after-treatment and a good functional result a scapho-lunate dissociation was proved.An avascular defect of the lunate could be excluded by magnetic resonance imaging. In case of a secondary performed dorsal repair a persisting carpal stabilization with a satisfactory functional result could achieved.At second hand an advanced carpal collapse was proved. CONCLUSIONS: If reduction cannot be achieved by closed manipulation or a loss of reduction is shown, open reduction is indicated first by a palmar approach. An additional dorsal ligamentous repair seems to be necessary.Transfixation by Kirschner wires and suture anchors stabilize the restored anatomic relationships.Wrist immobilization in a cast for at least eight weeks is recommended.Although ligamentous insufficiency, osteoarthrosis and avascular necrosis are often proved, functional results are satisfactory.     

Bilateral volar lunate dislocation

A 12 years follow-up of a case of bilateral volar lunate dislocation treated by open reduction and K-wire stabilisation of both wrists six days after injury is described. Despite aseptic necrosis of both lunates, the patient is pain free and has useful function, without the development of lunate ischaemia and collapse, carpal instability or posttraumatic osteoarthritis.     

Palmar lunate transtriquetral fracture dislocation

A palmar lunate transtriquetral fracture dislocation with a concomitant radial styloid avulsion fracture has not been described before in the literature. This injury represents an interesting variation of stage IV perilunar instability. Treatment was complicated by persistent scapholunate dissociation (rotary subluxation of the scaphoid) after attempted closed reduction and percutaneous pinning. At open reduction, the proximal half of the triquetrum, which had been dislocated palmarward with the lunate and which had been thought to be reduced after our attempted closed reduction was indeed returned to its normal position. However, it was rotated 180 degrees on its transverse axis. Restoration of the normal scapholunate interval was not possible until the triquetral fracture was reduced.     

Palmar dislocation of the scaphoid and lunate

A case of palmar dislocation of the scaphoid and lunate was complicated by a delay in the diagnosis and avascular necrosis of the lunate. Anatomic reduction was obtained 34 days after the injury. At 2 1/2 years follow-up the patient had good return of hand function and radiologic evidence of resolution of the avascular necrosis without evidence of collapse or intercarpal arthritis.     

Concurrent palmar lunate dislocation and posterior elbow dislocation: a case report

We report a rare case of concurrent palmar lunate dislocation of the left wrist combined with a posterior dislocation of the left elbow joint in a 40-year-old man. He sustained both injuries after falling onto his outstretched left hand. The elbow was reduced by the closed method. The wrist was treated with open reduction with carpal tunnel decompression and fixation with a Kirschner wire through the volar approach. Both the scapholunate and radioscaphocapitate ligaments were also repaired. At month 3, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a porter.     

Epidemic lunate dislocation and a single-handed method of reduction

Dislocation of the lunate bone in the wrist is one of the more common carpal injuries.An epidemic of these injuries during the war led to a simplified method being developed. The usual reduction can be tiring and difficult because of the sustained traction required. These problems were overcome by the simple method of the surgeon's forearm working in front of the patient's forearm so that with interlocked fingers considerable mechanical advantage and sustained traction could be employed, leaving the other hand free for direct pressure on the dislocated bone. Reduction was achieved by this method in a bilateral case that had been missed for a week.     

Palmar-divergent dislocation of the scaphoid and the lunate

We describe a patient with palmar-divergent dislocation of the scaphoid and lunate. After successful closed reduction, the scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, and the anterior capsule was sutured through the palmar approach. The scapholunate and lunotriquetral joints were fixed with Kirschner wires for 7 weeks. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate, and radiographs showed no evidence of the dorsal and volar intercalated segment instability patterns associated with carpal instability. However, flexion of the scaphoid and a break in Gilula’s line remained. To our knowledge, this is the first report showing treatment of palmar-divergent dislocation of the scaphoid and lunate by suturing the carpal interosseous ligaments.     

Palmar dislocation of scaphoid and lunate as a unit

A case of closed palmar dislocation of the scaphoid and lunate as a unit is described. This was treated by closed reduction and resulted in a good functional result as assessed at 1-year follow-up. No aseptic necrosis of the lunate or of the scaphoid developed. The only residual abnormality was an asymptomatic x-ray VISI pattern of the lunate. This is attributed to the disruption of the lunotriquetral joint. A functional analysis of the x-ray films with the wrist in radial and ulnar deviation indicated a normal arthrokinematic pattern.     

Palmar lunate dislocation with a dorsal scaphoid fracture variant

A 20-year-old man had a dorsally displaced fracture of the proximal pole of the scaphoid and an ipsilateral palmar lunate dislocation--a rare combination of injuries that has not been previously reported. The most likely pathomechanics of this injury is a sheer fracture of the proximal pole of the scaphoid by the dorsal lip of the distal radius as the injury shifts from a dorsal perilunate to a palmar lunate pattern.     

改良牵引折顶法整复月骨脱位

自1995—2004年，采用改良牵引折顶法整复新鲜月骨前脱位11例，效果满意，现总结报告如下。     

Ipsilateral Monteggia fracture dislocation with volar lunate dislocation of wrist: a case report

We present a previously undescribed case of ipsilateral Bado type II Monteggia fracture with volar lunate dislocation. The dislocation was reduced with repair of the volar capsule; ulna was plated and the comminuted radial head was excised. This case is reported for its rarity and its management. Complete diagnostic evaluation is imperative to avoid missed injuries and achieve satisfactory outcome.     

Transtriquetral perihamate ulnar axial dislocation and palmar lunate dislocation.

Transtriquetral perihamate ulnar axial dislocation associated with palmar lunate dislocation is a rare condition. We could find no other similar cases reported. The mechanism of injury was a combined anteroposterior crushing force that caused axial disruption of the carpus and the metacarpals and wrist hyperextension that caused the transtriquetral lunate dislocation. Our patient was treated with open reduction and internal fixation with good result.     

Aortic dissection in a weight lifter with nodular fasciitis of the aorta

We report a case of spontaneous aortic dissection in a young weight lifter without aortic medial disease but with a myofibroblastic proliferation of the aortic adventitia consistent with nodular fasciitis. Successful treatment included ascending aorta replacement with Dacron graft and aortic valve resuspension. We believe that the underlying aortic pathology most likely contributed to the development of the aortic dissection.