Stage 4 Reverse Perilunate Injury: A Proposed Addition to an Existing Classification and Case Report

This report describes a 53-year-old man who sustained a reverse perilunate injury (REPLI) including disruption of all ligaments that have been previously described in addition to the short radiolunate ligament resulting in a dorsal lunate dislocation. This was treated with open reduction and internal pin fixation through a dorsal approach. At final follow-up of four years, the patient had radiographic evidence of ulnocarpal translation. Despite this, he was doing well clinically. We propose that the disruption of the short radiolunate ligament, leading to a dorsal lunate dislocation, should be included in the existing REPLI staging system as a Stage 4 injury.