@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!)
259 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books.
259 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents.
259 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)!
264 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!!
275 days ago
Besides making frequent appearances on emergency medicine standardized exams, carpal dislocations, most commonly lunate and perilunate dislocations, present frequently to Emergency Departments. They are orthopedic emergencies and can be associated with significant complications.
Lunate dislocation (top image) occurs when the lunate is displaced and subluxed anteriorly. This often subluxes into the carpal tunnel causing an acute median neuropathy. It is seen as a “moon-“ or “saucer-shaped” bone flipped volarly, with the more distal capitate sliding proximally against the distal radius.
Perilunate dislocation
In a perilunate dislocation, the lunate-radius articulation is preserved and the capitate (as well as the entire distal carpal row with attached metacarpals) “jumps” dorsally “out of the saucer”.
Both of these carpal dissociations are often associated with scaphoid fracture and always portend significant ligamentous damage usually requiring operative repair.
Kienbock's disease
Another classic complication is Kienbock’s disease, or avascular necrosis of the lunate bone, which occurs with interruption of the bone’s tenuous blood supply, as in the scaphoid. Notice loss of bone density and height.
Besides making frequent appearances on emergency medicine standardized exams, carpal dislocations, most commonly lunate and perilunate dislocations, present frequently to Emergency Departments. They are orthopedic emergencies and can be associated with significant complications.
Lunate dislocation (top image) occurs when the lunate is displaced and subluxed anteriorly. This often subluxes into the carpal tunnel causing an acute median neuropathy. It is seen as a “moon-“ or “saucer-shaped” bone flipped volarly, with the more distal capitate sliding proximally against the distal radius.
In a perilunate dislocation, the lunate-radius articulation is preserved and the capitate (as well as the entire distal carpal row with attached metacarpals) “jumps” dorsally “out of the saucer”.
Both of these carpal dissociations are often associated with scaphoid fracture and always portend significant ligamentous damage usually requiring operative repair.
Another classic complication is Kienbock’s disease, or avascular necrosis of the lunate bone, which occurs with interruption of the bone’s tenuous blood supply, as in the scaphoid. Notice loss of bone density and height.
See prior post about normal wrist anatomy on xray .
References
Wheeless, C. “Perilunate dislocations.” Wheeless’ Textbook of Orthopaedics N.p., 30 Nov. 2008 Web. 17 Apr. 2010.
Voigt, C. Injury to the heel of the hand. Unfallchirurg. 2006; 109(4):313-22.
This "EM Lightbox" case was authored by guest blogger, Dr. Eric Silman.