This landmark cadaveric study loaded 32 wrists to failure to define the pathomechanics of perilunate and lunate dislocations. It asks: what tears, in what order, and can that sequence explain every injury from isolated scapholunate diastasis to frank lunate dislocation? The answer became the Mayfield classification of perilunar instability.
A perilunate injury is not a random ligamentous explosion — it is a predictable sequence you can read off the X-ray. The Mayfield framework gives you a roadmap: find out where the arc stopped, and you know exactly which ligaments are down.
When you see a volar triquetral avulsion fracture or triquetrolunate diastasis on the AP view, that is Stage III until proven otherwise. When the lunate has rotated palmarly on the lateral view and appears triangular on the AP, you are looking at Stage IV. Both require combined dorsal-volar open repair. Closed reduction will not hold.
The radial styloid fracture deserves the same attention: a body fracture tells you the radiocapitate ligament has avulsed, and the distal carpal row is destabilized. Do not treat it as an isolated bony injury without imaging the carpus carefully for perilunar instability.
The closed-reduction paradox from this paper is why modern consensus favors operative management for Stage III–IV injuries: no single wrist position can simultaneously restore scapholunate alignment and approximate the torn volar ligaments.
This landmark cadaveric study loaded 32 wrists to failure to define the pathomechanics of perilunate and lunate dislocations. It asks: what tears, in what order, and can that sequence explain every injury from isolated scapholunate diastasis to frank lunate dislocation? The answer became the Mayfield classification of perilunar instability.
A perilunate injury is not a random ligamentous explosion — it is a predictable sequence you can read off the X-ray. The Mayfield framework gives you a roadmap: find out where the arc stopped, and you know exactly which ligaments are down.
When you see a volar triquetral avulsion fracture or triquetrolunate diastasis on the AP view, that is Stage III until proven otherwise. When the lunate has rotated palmarly on the lateral view and appears triangular on the AP, you are looking at Stage IV. Both require combined dorsal-volar open repair. Closed reduction will not hold.
The radial styloid fracture deserves the same attention: a body fracture tells you the radiocapitate ligament has avulsed, and the distal carpal row is destabilized. Do not treat it as an isolated bony injury without imaging the carpus carefully for perilunar instability.
The closed-reduction paradox from this paper is why modern consensus favors operative management for Stage III–IV injuries: no single wrist position can simultaneously restore scapholunate alignment and approximate the torn volar ligaments.