A 22-year-old man falls on an outstretched hand. Radiographs show the capitate and remaining carpals displaced dorsally relative to the lunate, whose articular surface faces volarward. He develops progressive tingling in the thumb, index and middle fingers within hours. The most appropriate immediate step is:

• A Splintage and elective open reduction after two weeks
• B Urgent closed reduction followed by definitive fixation ✓
• C Immediate carpal tunnel decompression alone
• D Proximal row carpectomy

Explanation

This is a dorsal perilunate dislocation. The lunate tilts volarward into the carpal canal and acutely compresses the median nerve, an emergency requiring urgent reduction. Closed reduction under anaesthesia is performed promptly, followed by open reduction and ligamentous or percutaneous fixation once swelling permits, ideally within days. Delayed fixation increases avascular necrosis of the lunate and chronic instability. Decompression alone leaves the dislocation untreated, and salvage procedures such as carpectomy are last resorts.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.