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"perilunate dislocation" OR "distal radius fracture"

Reading File
Probable carpal dislocation, most likely a perilunate or lunate dislocation, possibly with an associated fracture. This is a provisional read from a phone photo of a film, so it isn't a definitive diagnosis.
My automated image analysis failed, so this is based on my own look at the image. The picture is angled, with glare and reflection. The film is labelled "D. Sarada, 55Y F".
What I see on this PA wrist view
  • The carpal bones are crowded and overlap in the middle of the wrist. They don't form the normal smooth arcs (Gilula lines).
  • A rounded, wedge-shaped carpal bone sits at the radius's articular surface. This fits a lunate that has rotated toward the palm.
  • The radiocarpal and midcarpal joint spaces are uneven.
  • The distal radius and ulna look largely intact on this single view, but I can't exclude a small fracture. The scaphoid and the ulnar and radial styloids need checking on better images.
  • The panel on the right shows a foot or ankle, not the wrist. Please check that the films belong to the same patient and study.
Why I favour perilunate or lunate dislocation Rockwood and Green's lists the PA signs of a perilunate injury. They include disrupted Gilula lines, a triangular lunate from palmar rotation, and a spilled-teapot sign on the lateral view. The lateral view is the key film, and this image doesn't include one. The textbook also notes that about 20% of these injuries are missed at first presentation (Rockwood and Green's Fractures in Adults, 10th ed., Perilunate Dislocation and Fracture-Dislocation). Greater-arc injuries with an associated fracture, most often trans-scaphoid, are about twice as common as pure ligamentous ones.
Other possibilities
  • Scapholunate dissociation or another carpal instability.
  • A distal radius fracture with carpal malalignment.
  • An oblique or poorly positioned view that only makes the carpus look disrupted.
Next steps
  1. Get true PA and lateral views, plus a clear, straight-on photo or the original image file. A CT scan helps to define fractures.
  2. Look for median nerve symptoms (numbness, acute carpal tunnel syndrome). Reduce and splint promptly.
  3. Refer to orthopaedics or hand surgery. These injuries usually need surgical fixation, and delay worsens the outcome.
A 2025 systematic review (PMID 40617527) covers the outcomes of chronic or missed perilunate dislocations. It doesn't contradict the textbook on this point.
If you tell me the mechanism of injury, the symptoms and the exam findings, I can narrow this down. A lateral view would help most.

it's foot ap xray

Finding Sources
Finding Sources
I misidentified the body part in my first answer. This is a foot AP film that also includes the ankle (distal tibia and fibula), with a lateral ankle view beside it. Please disregard the wrist and perilunate discussion.
My reading is tentative, because this is a glare-affected phone photo of a film.
What I think I see:
  • Midfoot and tarsal region: The bones look crowded and overlapping, and the normal joint lines are hard to follow. The metatarsal bases look splayed and misaligned.
  • Soft tissue: There is a bulge on the medial side of the midfoot, which fits swelling.
  • Ankle mortise: The tip of the fibula (lateral malleolus) sits higher than I'd expect relative to the talus. That could mean the hindfoot is displaced or a fracture is shortening the fibula, but I can't tell which from this photo.
Possible diagnoses, from most to least likely given the pattern
  1. Lisfranc (tarsometatarsal) fracture-dislocation. The AP film is checked for these signs:
    • The medial edge of the 2nd metatarsal base should line up with the medial edge of the intermediate cuneiform. Failure of that line suggests lateral displacement of the metatarsals.
    • The 1st and 2nd metatarsal bases are normally less than about 2 mm apart.
    • A small "fleck" fragment near the 2nd metatarsal base suggests avulsion of the Lisfranc ligament.
    • Fractures of the 2nd to 4th metatarsal bases often accompany it (Grainger & Allison's Diagnostic Radiology, Lisfranc Injury; Rosen's Emergency Medicine, Fig. 49.20).
  2. Chopart (midtarsal) injury, or a talar or subtalar dislocation if the hindfoot is also displaced.
  3. Talus or calcaneal fracture, or an ankle fracture-dislocation. These need the lateral views to judge.
I can't confirm any of these from this image. Some of the apparent overlap may come from the film angle or the photo.
Next steps
  • Get weight-bearing views if the patient can tolerate them, or stress views otherwise. This means AP, oblique and lateral views of the foot, plus a mortise view of the ankle.
  • Get a CT scan. It is the best test for suspected Lisfranc or hindfoot injury, and subtle injuries are often missed on plain films.
  • Check the dorsalis pedis pulse, capillary refill and sensation, and watch for compartment syndrome. Dislocations can compromise circulation.
  • Refer to orthopaedics early. Unstable Lisfranc injuries usually need fixation, and missed ones lead to chronic pain and midfoot arthritis.
Please send a straight-on image or the lateral view if you have it, and tell me the mechanism of injury (twist, fall, crush) and where she is tender. With that I can give a firmer read.
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