Transnavicular perilunate dislocations.

A complex injury of the wrist, the transnavicular perilunate dislocation, is analyzed along with a review of the literature. A method of management is proposed for this injury based on experience gained with nine such injuries. Our conclusion is that open reduction and internal fixation is a necessity unless an anatomic manipulative reduction can be accomplished. It is proposed that a navicular bone graft be employed at 6 weeks if avascular necrosis of the navicular and early signs of nonunion are evident. The rationale for these proposals is discussed.