702 Correspondence and communications

Alan S. LivingstoneDepartment of Surgery, University of Miami,P.O. Box 016960 (R-88), Miami, FL 33101, USA

ª 2010 British Association of Plastic, Reconstructive and AestheticSurgeons. Published by Elsevier Ltd. All rights reserved.

doi:10.1016/j.bjps.2010.10.005

Questions about ‘Posteriorperilunate carpal dislocationassociated with amultifragmentary distal radiusfracture’

Sir:

I just read the case report ‘Posterior perilunate carpaldislocation associated with a multifragmentary distal radiusfracture’ and have several questions that I believe I andother readers would appreciate the authors answering: 1

1. The immediate post-operative radiographs (Figure2)suggest that the distal radioulnar joint is not congruent,yet the authors claim that there was normal pronationand supination as demonstrated in figure 3. I see nodemonstration of normal pronation in figure 3. Neitherthe elbow nor shoulder is shown in the photograph,hence, it is possible that the patient was using trickmovements to pronate and supinate. In light of the

distal radioulnar joint injury, I would not expect thepatient to have normal pronation or supination.Do you have photographs that show the patients prona-tion and supination as measured with an inclinometer orProsupinator� and with his elbow stabilised?

2. The authors state that the patient developed complexregional pain syndrome that required treatment. Figure 3lower right shows clawing of the ring and small digits andfigure 3 lower left suggests a hint of hollowness of the firstwebspace where the first dorsal interosseous muscle is.Did this patient have an ulnar nerve problem?

3. Since this patient was followed for 2 years, could youshow us radiographs that are later than the immediatepost-operative period and are not obscured by hardware?

Reference

1. Henault B, Duvernay A, Tchurudichian A, Trouilloud P, Malka G,Trost O. Posterior perilunate carpal dislocation associated witha multifragmentary distal radius fracture. J Plast Reconst Aes-thet Surg 2010;63:1926e8.

M. Felix FreshwaterDepartment of Surgery

University of Miami School of Medicine,9100 S Dadeland Blvd Ste 502,

Miami FL 33156-7815, United StatesE-mail address: m.felixfreshwater@gmail.com

ª 2010 British Association of Plastic, Reconstructive and AestheticSurgeons. Published by Elsevier Ltd. All rights reserved.

doi:10.1016/j.bjps.2010.03.060