Lunatotriquetral injury is an important cause of wrist instability. It can occur either in isolation or as a part of perilunate dislocations. Lunatotriquetral joint is between the medial surface of the lunate and the lateral surface of the triquetrum.
Presentation of Lunatotriquetral Dissociation
Lunatotriquetral injuries commonly result from a sudden axial load, such as a fall. The patient present with complaint of ulnar sided wrist pain.
The pain would be aggravated by activity.
On examination, there would be tenderness on the area of lunatotriquetral joint. In quite a number of cases, Stress loading of the LT joint (compression, ballottement, or shear) of the unstable triquetrum may be carried.
Out of them shear test is most sensitive.
Imaging of Lunatotriquetral Dissociation
It is difficult to make a radiographic diagnosis on routine films and therefore clinical examination is of utmost importance.
A disruption of Gilula lines may be visible. A static volar intercalated segment instability deformity also implies an injury to the lunatotriquetral ligament because there is dissociation between lunate and triquetrum.
Most reliable investigation for lunatotriquetral instability is arthroscopy.
Treatment of Lunatotriquetral Dissociation
In acute cases with minimal deformity, a well-molded Colles cast is used after reduction.
Closed reduction and percutaneous internal fixation of the lunate to the triquetrum is done in cases with displacement.
If nonoperative measures fail to address the problme, surgical intervention can be considered.
Arthroscopy can be used to aid in closed reduction.
Open reduction, repair of the ligament and and temporary internal fixation for6-8 weeks with percutaneous wires across the triquetrum and lunate should be carried in cases not helped by arthro
If there is a tendency for recurrence, lunatotriquetral fusion is indicated.
Proximal row carpectomy [removal of proximal row of carpus] and total wrist arthrodesis in patients are done in cases with established wrist arthrosis.
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