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An unusual weightlifting injury
Injury
(1988) 19,446- 454
Printed in Great Britain
446
Case Reports An unusual weightlifting
injury
J. R. Wooton and D. H. Jones Ysbyty G wynedd, Bangor, G wynedd INTRODUCTION WE report a 25year-old weightlifter who bilateral transtriquetral perilunate dislocations cuss the mechanism of his injuries.
sustained and dis-
CASE REPORT A 25year-old weightlifter raised 50 Ibs above his head but then overbalanced and fell backwards. He clung tightly to the bar to
prevent it striking his face and as his elbows hit the ground a violent dorsiflexion force was transmitted to his wrists. He attended our accident unit the same day. On examination he had symptoms of left carpal tunnel compression, both wrists were painful, swollen and stiff and there were abrasions at the back of his elbows. Radiographs showed bilateral transtriquetral perilunate dislocations (Fig. la-d).
d Fig. 1. ~1,b Radiographs
of right wrist on admission. c, d, Radiographs of left wrist on admission.
a
b
C
Fig. 2. a, b, Radiographs of right wrist after reduction. c, d, Radiographs of left wrist after reduction.
01988 Butterworth & Co (Publishers) Ltd 002Cr1383/8S/060446a2$03.00
d
Case reports
c
b
a
d
Fig. 3. a, b, Right wrist at 4 months. c, d, Left wrist at 4 months.
Under general anaesthesia manipulative reduction was attempted. This was easily achieved on the right but not on the left (Fig. 2a, b).
Through a volar approach the left wrist was exposed, decompressing the carpal tunnel. The lunate and proximal fragment of triquetrum had together button-holed through the radiocarpal ligament and reduction could only be effected by a releasing incision (Fig. 2c, d). Postoperatively the symptoms of median nerve compression disappeared. Below-elbow plaster-of-Paris splints were applied for 6 weeks. Thereafter he mobilized rapidly and when reviewed 4 months after his injury he had regained full movements and was back at work as a machine operator. Repeat radiographs showed the fractures to be united (Fig. 3a-d).
In this position the scaphoid is in the flexed position (Fisk, 1970). This makes it resistant to fracture but the triquetral is rendered more vulnerable. The important stabilizing effect of an intact scaphoid is suggested as a factor in the successful outcome of this injury.
REFERENCES Bonnin J. G. and Greening W. P. (1944) Fractures of the triquetrum. Br. J. Surg. 31, 278. Campbell R. D., Lance E. M. and Chin Bor Yedh (1964) Lunate and perilunar dislocations. J. Bone Joint Surg. 46B, 55. Fisk G. R. (1970) Carpal instability and the fractured scaphoid. Ann. R. Coil. Surg. Engl. 46,63.
DISCUSSION
Transtriquetral perilunate dislocation is rare among injuries of the carpus (Campbell et al., 1964) and we know of no other reported bilateral case. Our patient described his injury very clearly. At the time of impact his hands were approximately 1 m apart with the wrists in radial deviation.
Fisk G. R. (1980). An overview of injuries of the wrist. Clin. Orthop. 1980 JUN ( 1949) 134. Nunn D. (1986) Transtriquetral midcarpal dislocation. J. Hand Surg. 11B,432.
Paper accepted 2 June 1988.
Requestsfor reprintsshould be addressed to: J. Wooton, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Salop.
Irreducible dislocation a report of two cases
of the subtalar
joint:
L. J. Taylor and A. Burke The Royal Adelaide
Hospital,
Adelaide,
South Australia
Summary
Two patients with irreducible lateral dislocation of the subtalar joint are reported. In both patients the injury was closed and associated with a lateral calcaneal fracture. Open reduction confirmed the tendon of tibialis posterior was located around the lateral aspect of the neck of the talus and prevented reduction. (c‘!Butterworth & Co (Publishers) Ltd OOZGI383/88/06044743.$03.00
INTRODUCTION DISLOCATION of the subtalar joint is an uncommon injury accounting for less than 2 per cent of all dislocations
(DeLee and Curtis, 1982); 20 per cent are lateral (Leitner, 1954; DeLee and Curtis, 1982). Lateral dislocation of the subtalar joint is more frequently open and may be as-
(1988) 19,446- 454
Printed in Great Britain
446
Case Reports An unusual weightlifting
injury
J. R. Wooton and D. H. Jones Ysbyty G wynedd, Bangor, G wynedd INTRODUCTION WE report a 25year-old weightlifter who bilateral transtriquetral perilunate dislocations cuss the mechanism of his injuries.
sustained and dis-
CASE REPORT A 25year-old weightlifter raised 50 Ibs above his head but then overbalanced and fell backwards. He clung tightly to the bar to
prevent it striking his face and as his elbows hit the ground a violent dorsiflexion force was transmitted to his wrists. He attended our accident unit the same day. On examination he had symptoms of left carpal tunnel compression, both wrists were painful, swollen and stiff and there were abrasions at the back of his elbows. Radiographs showed bilateral transtriquetral perilunate dislocations (Fig. la-d).
d Fig. 1. ~1,b Radiographs
of right wrist on admission. c, d, Radiographs of left wrist on admission.
a
b
C
Fig. 2. a, b, Radiographs of right wrist after reduction. c, d, Radiographs of left wrist after reduction.
01988 Butterworth & Co (Publishers) Ltd 002Cr1383/8S/060446a2$03.00
d
Case reports
c
b
a
d
Fig. 3. a, b, Right wrist at 4 months. c, d, Left wrist at 4 months.
Under general anaesthesia manipulative reduction was attempted. This was easily achieved on the right but not on the left (Fig. 2a, b).
Through a volar approach the left wrist was exposed, decompressing the carpal tunnel. The lunate and proximal fragment of triquetrum had together button-holed through the radiocarpal ligament and reduction could only be effected by a releasing incision (Fig. 2c, d). Postoperatively the symptoms of median nerve compression disappeared. Below-elbow plaster-of-Paris splints were applied for 6 weeks. Thereafter he mobilized rapidly and when reviewed 4 months after his injury he had regained full movements and was back at work as a machine operator. Repeat radiographs showed the fractures to be united (Fig. 3a-d).
In this position the scaphoid is in the flexed position (Fisk, 1970). This makes it resistant to fracture but the triquetral is rendered more vulnerable. The important stabilizing effect of an intact scaphoid is suggested as a factor in the successful outcome of this injury.
REFERENCES Bonnin J. G. and Greening W. P. (1944) Fractures of the triquetrum. Br. J. Surg. 31, 278. Campbell R. D., Lance E. M. and Chin Bor Yedh (1964) Lunate and perilunar dislocations. J. Bone Joint Surg. 46B, 55. Fisk G. R. (1970) Carpal instability and the fractured scaphoid. Ann. R. Coil. Surg. Engl. 46,63.
DISCUSSION
Transtriquetral perilunate dislocation is rare among injuries of the carpus (Campbell et al., 1964) and we know of no other reported bilateral case. Our patient described his injury very clearly. At the time of impact his hands were approximately 1 m apart with the wrists in radial deviation.
Fisk G. R. (1980). An overview of injuries of the wrist. Clin. Orthop. 1980 JUN ( 1949) 134. Nunn D. (1986) Transtriquetral midcarpal dislocation. J. Hand Surg. 11B,432.
Paper accepted 2 June 1988.
Requestsfor reprintsshould be addressed to: J. Wooton, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Salop.
Irreducible dislocation a report of two cases
of the subtalar
joint:
L. J. Taylor and A. Burke The Royal Adelaide
Hospital,
Adelaide,
South Australia
Summary
Two patients with irreducible lateral dislocation of the subtalar joint are reported. In both patients the injury was closed and associated with a lateral calcaneal fracture. Open reduction confirmed the tendon of tibialis posterior was located around the lateral aspect of the neck of the talus and prevented reduction. (c‘!Butterworth & Co (Publishers) Ltd OOZGI383/88/06044743.$03.00
INTRODUCTION DISLOCATION of the subtalar joint is an uncommon injury accounting for less than 2 per cent of all dislocations
(DeLee and Curtis, 1982); 20 per cent are lateral (Leitner, 1954; DeLee and Curtis, 1982). Lateral dislocation of the subtalar joint is more frequently open and may be as-