The pain in the sprain, is mostly in the…

Diagnostic Challenge

CJEM 1999;1(2):127

A 21-year-old female presented to the emergency department complaining of wrist pain following a fall onto her outstretched (dominant) right hand. The injury occurred the previous night while the patient was riding her bike. She noticed some immediate wrist pain but believed it was only a ³sprain.² The next morning she awoke with considerably more pain and was unable to move the affected wrist. She suffered no other injuries and was otherwise healthy.

On examination, the skin was intact and neurovascular examination was normal. There was marked swelling over the dorsal carpometacarpal area, but range of motion of all digits was maintained. Wrist flexion and extension were approximately 15 degrees each. Pronation and supination were limited and produced significant pain. There was tenderness on palpation of the anatomical snuffbox and over the proximal row of carpal bones. X-rays of the affected wrist are provided here.

Fig. 1. Anterior-posterior view, with widening of the scapholunate space.

Fig. 2. Lateral view, showing a dorsal triquetral fracture.

What is your diagnosis?

1. Scapholunate dissociation with a triquetral fracture

2. Perilunate dislocation

3. Lunate dislocation

4. Capitate fracture

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