Dislocated hand

Dislocations of the wrist and its individual bones are quite rare. The most common dislocation is the lunate bone, and dislocations of the wrist distal to the first row of carpal bones are also recorded.

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What causes a wrist dislocation?

Dislocations of the wrist most often occur on the dorsal side, less often on the palmar side. The cause of occurrence is excessive extension or flexion in the wrist joint.

Symptoms of a wrist dislocation

Anamnesis

The anamnesis indicates a corresponding injury.

Inspection and physical examination

Characteristic symptoms are pain, bayonet-shaped deformation of the wrist joint, swelling, and dysfunction. Palpation reveals pain and distortion of the wrist joint shape, and a positive symptom of springy resistance.

Perilunate dislocation of the wrist

Perilunate dislocation of the wrist is a dislocation of the wrist distal to the lunate bone, which continues to maintain congruence with the radius.

ICD-10 code

S63.0. Dislocation of wrist.

Symptoms

Symptoms and diagnostics are similar to those of a wrist dislocation, a typical radial fracture, and other types of fracture-dislocations. The uniformity of the clinical picture is a consequence of the wrist being displaced to the back.

Diagnostics

X-ray examination resolves doubts.

Treatment

General anesthesia. After intensive traction along the longitudinal axis and dorsiflexion of the hand, the surgeon presses with the thumbs on the protruding part of the dorsal surface of the wrist, and with the remaining fingers provides counter-support to the distal part of the forearm. After eliminating the dislocation, the hand is bent at an angle of 135° and fixed with a plaster cast for 3 weeks. After this, the hand is brought to a functionally advantageous position and immobilized with a plaster cast for another 3 weeks.

Approximate period of incapacity

They start working after 10-12 weeks.

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Scaphoid dislocation

ICD-10 code

S63.0. Dislocation of wrist.

Dislocation of the scaphoid bone occurs with excessive flexion and abduction of the hand to the ulnar side. The scaphoid bone, shifting, tears the joint capsule and dislocates to the dorsal-radial side.

Symptoms

Pain, swelling, edema and smoothing of the contours of the wrist joint, dysfunction are detected. Sometimes it is possible to palpate a painful protrusion in the area of the anatomical snuffbox.

Diagnostics

The radiograph reveals a dislocation of the scaphoid bone.

Treatment

General anesthesia is preferable. Traction of the hand along the axis of the forearm with abduction to the ulnar side. The surgeon presses with the thumbs on the dislocated bone, returning it to its previous position. The hand is given a position of dorsal flexion and abduction to the ulnar side, the limb is fixed with a circular plaster cast from the elbow joint to the heads of the metacarpal bones for 3 weeks, and then immobilization is replaced with a removable splint for another 3 weeks.

Approximate period of incapacity

Working capacity is restored within 6-8 weeks.

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Lunate dislocation

ICD-10 code

563.0. Dislocation of the wrist.

Lunate dislocation occurs as a result of excessive extension of the wrist, which causes excessive pressure of the capitate bone on the lunate bone and displacement of the latter to the palmar side.

Symptoms

The wrist is thickened on the palmar side, a painful protrusion is determined above the volar fold, the fingers are half-bent. Movements in the wrist joint are limited due to sharp pain, the patient cannot clench his fingers into a fist or fully straighten them. Neurological symptoms may appear as a result of damage to the median nerve.

Diagnostics

X-ray confirms the diagnosis of lunate dislocation.

Conservative treatment

Under anesthesia, strong and prolonged traction is applied along the length, and then pressure is applied to the dislocated bone in the dorsal direction, returning it to its previous position. A plaster cast is applied for 3 weeks, then converted into a removable cast for another 1-2 weeks.

Surgical treatment

In case of chronic or irreducible dislocations of the hand and wrist bones, external fixation devices are used to create sufficient distraction and eliminate the dislocation, or surgical treatment is used - open reduction of the dislocated segment.

Approximate period of incapacity

The patient can return to work in 5-6 weeks.

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Diagnosis of wrist dislocation

The x-ray reveals a dislocation of the wrist.

Treatment of wrist dislocation

The complexity of the structure and importance of the functions of the hand require highly qualified treatment at all stages of injury, so patients should be referred to hand surgery departments or traumatology departments.

Conservative treatment

After anesthesia (any method is applicable), the forearm is bent at an angle of 90°, the shoulder is fixed. Traction is applied to the hand along the axis of the forearm, and then the dislocated segment is dislocated to the dorsal or palmar side (opposite to the displacement). After the hand is repositioned, which is almost always successful, a circular plaster cast is applied from the heads of the metacarpal bones to the elbow joint. X-ray control is mandatory. The period of permanent immobilization is 4 weeks, after which rehabilitation treatment begins, but the removable plaster splint is retained for another 2-3 weeks.

Surgical treatment

Surgical treatment is indicated when attempts at conservative reduction of the dislocation are unsuccessful.

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Approximate period of incapacity

The average recovery period for working capacity is 7-8 weeks.