Small Bones Dislocation
There are many different small bones of the hand and wrist which have the potential to be injured in auto accidents and other types of traumatic injuries. One of these small bones is called the navicular, also commonly referred to as the scaphoid.
What is a Navicular Dislocation?
Most hand fractures and wrist fractures result from a fall on an outstretched hand or direct trauma to the region, such as traumatic contact while playing sports. The navicular is one of the largest bones in the hand. A dislocation of the navicular is relatively uncommon and involves the scaphoid (or navicular) being displaced in a dorsal manner following trauma. It requires an experienced radiologist to diagnose properly because the dislocation is so rare.
The Injury Mechanism
While it is one of the less common bone fractures and dislocations people can sustain, there are several ways that this dislocation can occur. Some people fracture or dislocate their navicular after falling on an outstretched hand; however, this injury is also seen in car accidents. In an auto accident, people can extend their hands against the steering wheel to brace themselves. If their hand and wrist strike the steering wheel with enough force, the navicular can become dislocated.
Treatment of a Navicular Dislocation
To properly diagnose a dislocation of the navicular, multiple imaging studies, such as x-rays, CT scans, and an MRI, are often necessary. Once the dislocation has been confirmed, any ancillary fractures must also be identified. Sometimes, this bone can be reduced (placed back in its proper position), without requiring surgery; however, ligaments might be damaged and other bone fractures might be present. If this is the case, the patient will require surgery.
Complications are Possible
A navicular dislocation has a variety of complications and comorbidities that can accompany this injury. Most notably, the blood supply of the hand and wrist comes in near the navicular bone. If this bone has been dislocated, the blood supply could be cut off. This leads to a condition called avascular necrosis, or death of the tissues of the hand and wrist. It is also not uncommon for patients with a history of a navicular dislocation to develop arthritis at an earlier age because the articulation between the bones of the hand has been damaged.
What Other Structures Might be Damaged?
As mentioned above, the blood vessels that supply nutrients and oxygen to the bones and tissues of the hand and wrist are at risk. In addition, the muscles that give the hand its grip strength can be damaged when this bone is dislocated as well. Many patients have reported being unable to grip an object with the same strength. Other bones involved in pediatric wrist and hand fractures are also at risk, including the radius, lunate, and other carpal bones. A navicular dislocation is often accompanied by fractures to these bones. Finally, the radiocarpal joint is prone to developing osteoarthritis following a navicular dislocation.
Differential Diagnosis
This differential diagnosis for a Navicular Dislocation includes:
- Perilunar Dislocation
- Midcarpal Dislocation
- Navicular Fracture
- Colles Fracture
- Lunate Dislocation
- Triquetrum Fracture
- Pisiform Fracture
What is the Prognosis?
If the dislocation is identified and reduced quickly, the prognosis is generally very good; however, because this injury is uncommon, there is often a delay in diagnosis. The longer it takes to diagnose and reduce the dislocation, the higher the rate of complications.
Surgery Might be Necessary
Not every patient will require surgery; however, if the ligaments have been torn or if the dislocation cannot be reduced in a closed manner, the patient will require surgery.
Sacramento Bone Fracture & Personal Injury Lawyers
I’m Ed Smith, a Sacramento Personal Injury Lawyer. Patients who have suffered a traumatic fracture or dislocation involving their hand or wrist can call me at (916) 921-6400 for some free, friendly. My office has a toll-free line available at (800) 404-5400.
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