Dislocations of the wrist: carpal instability complex

Dislocations involving the carpus are among the most devastating injuries of the wrist. The more commonly encountered perilunate dislocations occur as the final stage of a mechanism progressing in a radial to ulnar direction. These injuries often are missed initially, potentially leading to serious complications. Patients presenting with high energy injuries about the wrist must be scrutinized carefully using standard wrist radiography and occasionally tomography. All dislocations of the carpus require prompt reduction. Better results from perilunate and lunate dislocations can be expected when dorsal and volar surgical approaches are used and the scapholunate interosseous ligament is repaired. Wrist stiffness, posttraumatic arthritis, and median nerve dysfunction may complicate carpal dislocations, even after early surgical attention.