A healthy young guy presented to the ED after being attacked by a shark. He had heard that the best way to defeat a shark in a fist fight is to punch it in the snout. He did just that, and started celebrating as the shark swam away in defeat. A few hours later he realized his hand/wrist were hurting so he checked in to the ED.
Here are his wrist x-rays:
AP view:
Oblique view:
So far so good. But before getting him teed up for discharge, might as well check out the lateral view:
Diagnosis: lunate dislocation
Normally the lateral view should show a nice alignment as such:
For medical students and EM residents, it’s not hard to tell that something is wrong. The key is being able to differentiate a lunate from a perilunate dislocation. This distinction is made on the lateral view.
Lunate dislocation: the lunate ‘spilling’ forward is known as the ‘spilled teacup’ sign
Treatment is the same for either: closed reduction. This needs to be done in the ED. Depending on your practice setting, either call in the friendly orthopedist or grab a C-arm and maybe a set of finger traps and get to it.
