Kozin's 1998 JAAOS review covers the anatomy, pathomechanics, diagnosis, and treatment of perilunate injuries — severe carpal disruptions that are frequently missed on initial presentation. The article systematically addresses how to recognize injury patterns on plain radiographs and when to escalate from closed to open reduction.
When a high-energy wrist injury presents with overlapping carpal bones, a triangular-appearing lunate on PA film, or median nerve symptoms, think perilunate injury and get true lateral and PA views immediately — missed diagnosis condemns the patient to progressive arthritis.
Closed reduction buys time and relieves median nerve compression, but plan for open reduction: restoration of anatomic carpal alignment is the single biggest driver of long-term outcome.
Kozin's 1998 JAAOS review covers the anatomy, pathomechanics, diagnosis, and treatment of perilunate injuries — severe carpal disruptions that are frequently missed on initial presentation. The article systematically addresses how to recognize injury patterns on plain radiographs and when to escalate from closed to open reduction.
When a high-energy wrist injury presents with overlapping carpal bones, a triangular-appearing lunate on PA film, or median nerve symptoms, think perilunate injury and get true lateral and PA views immediately — missed diagnosis condemns the patient to progressive arthritis.
Closed reduction buys time and relieves median nerve compression, but plan for open reduction: restoration of anatomic carpal alignment is the single biggest driver of long-term outcome.