Mayfield perilunar instability

Carpal dislocations: pathomechanics and progressive perilunar instability

Mayfield JK, Johnson RP, Kilcoyne RK The Journal of hand surgery 1980 · PMID 7400560 · doi:10.1016/s0363-5023(80)80007-4

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Question: What is the mechanism and sequence of ligament failure in perilunate carpal dislocations?
Design: Cadaveric biomechanical loading study correlated with clinical injury patterns.
Patients: Cadaveric wrists loaded in extension, ulnar deviation and intercarpal supination.
Intervention: Experimental loading to reproduce carpal injuries
Comparison: None
Primary outcome: Sequence of ligamentous disruption
Key result: Defined four progressive stages of perilunar instability: scapholunate disruption, capitolunate disruption, lunotriquetral disruption and finally volar lunate dislocation.
Limitations: Cadaveric model that may not reproduce all in vivo injury mechanisms, including greater-arc fracture-dislocations.
Impact on practice: The Mayfield staging is the standard framework for recognising and explaining perilunate injuries, which are frequently missed on initial radiographs and require urgent reduction and repair.