Case 15 Answer

We had a similar case earlier in the year, but no one was tricked and everyone gets a treat (ha..ha.. sorry for the Halloween pun). 

Answer: lunate dislocation

Notice the pie-shaped lunate on the frontal, but the lateral is the give-away with the lunate rotated volarly (towards the palm) with the remained of the carpal bones aligned (notice the scaphoid and the capitate still align up in our nice normal “concentric C” pattern. 

Short write up: http://radiopaedia.org/articles/lunate-dislocation

Keys to remember is that this is a more severe injury than the more commonly seen perilunate dislocation. This generally requires prompt surgical repair.