Wrist Dislocation

The wrist joint serves as a link between the hands and the upper body, and a great deal of force is transmitted through this joint. The specific arrangement of bones and the presence of ligaments provide flexibility to the joint. Although this flexibility helps in the movement of our hands and fingers, it also allows for dislocation.

Wrist dislocation means that the wrist bones have been knocked out of position or a bone has come out of place in the wrist joint. It is sometimes also referred to as carpal dislocation. Such an injury is common among athletes. It is usually experienced in sports with increased force vectors (height and speed), for example, adult inline skaters and football players. Other cases include falls from a height, as seen, for example, in gymnasts.

The most common cause of injury is high energy, but low-energy trauma has also been described as the cause of carpal dislocation in some reports.

Wrist dislocation is a serious injury and requires immediate emergency care. In a study by Larsen and Lauritsen, as many as 2.5% of all cases presented in various emergency departments of the United States are wrist injuries. Ten percent of all carpal injuries are subluxations and dislocations, perilunate dislocation being the most common type.

The initial evaluation and treatment of wrist injuries can be performed by emergency physicians and/or family practitioners. Early recognition of a dislocation and determination of proper treatment can prevent complications, including prolonged pain, discomfort, and surgery, and time lost from sports participation.

Types of Wrist Dislocation

Wrist dislocations can be divided into two types:

Perilunate dislocations: The lunate remains aligned with the radius, but the capitate dislocates. It is more common than lunate dislocation as the radial-lunate ligaments are stronger than the lunate-capitate ligaments. Seventy-five percent of the cases are associated with scaphoid fractures (known as trans-scaphoid perilunate dislocation).

Figure 1 Bones of the Wrist Joint

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Lunate dislocations: In these, the lunate bone dislocates, and the other carpal bones remain in alignment. This type of dislocation is less common than perilunate dislocation.