A 24 yo M presents after a fall from a bike onto an outstretched hand. He is complaining of L wrist pain and swelling. His wrist xray is shown below. What's the diagnosis? (scroll down for answer)

Answer: Peri lunate dislocation (also note fracture of the ulnar styloid process)

• Usually results from fall onto an outstretched/hyperextended hand or other high energy trauma
• In a peri-lunate dislocation, the lunate has normal or near normal alignment with distal radius, while other carpal bones are dorsally displaced
• In contrast to a lunate dislocation, in which the lunate has volar displacement (spilled teacup) and the remaining carpal bones have normal alignment
• Up to 25% are missed at time of initial presentation
• Surgical management indicated
• Left untreated, patients are at risk for median nerve injury, avascular necrosis, and long term wrist dysfunction