title: Complex and rare fracture patterns in perilunate dislocations.
abstract: BACKGROUND
  The wrist represents a complex anatomic region in the upper extremity and a highly functional and intricate structural joint. Perilunate injuries have classically been described as involving a greater or lesser arc as described by Mayfield and imply a specific pattern of force transmission. The greater and lesser arc classifications do not include descriptions of when non-scaphoid carpal fractures occur as part of a perilunate injury.
  
  
  RESULTS
  We present three cases of complex and rare perilunate fracture dislocation patterns and discuss the surgical management as a treatment model for these complex wrist injuries: the trans-scaphoid, trans-capitate perilunate dislocation, the trans-scapholunate ligament, trans-capitate dislocation, and the trans-scaphoid, trans-triquetral perilunate dislocation.
  
  
  CONCLUSIONS
  Although there is a low incidence of injury to non-scaphoid carpal bones, it is beneficial to understand the approach to the perilunate reduction and scaphoid fixation through a combined volar and dorsal approach, which will also allow for the reduction and fixation of more rare and complex carpal fractures.
authors.forename: John G
authors.initials: JG
authors.lastname: Apostolides
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lifchez
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy