Lunate and Perilunate Dislocations: Tips and Tricks for Problem Fractures

Abstract

Perilunate injuries represent a spectrum of insult to the carpus leading to progressive carpal instability. These injuries are most frequently associated with high-energy mechanisms and their diagnoses can be missed. Lunate and perilunate injuries may be purely ligamentous or involve fractures and dislocations of the carpal bones, most commonly the scaphoid (trans-scaphoid perilunate injury). This can be attributed to the complex interplay of the ligamentous and bony architecture of the wrist and resultant biomechanics. Accurate diagnosis relies on a thorough history and physical exam as well as scrutiny of adequate and quality radiographs.

Initial management typically involves closed reduction in the emergency department; however, even with acceptable closed reduction, operative intervention is favored. In the acute setting, specific operative treatment is dependent on type and severity of injury. Treatment ranges from direct ligamentous and soft tissue repair to carpal tunnel release and fracture fixation. In the setting of chronic perilunar injuries, salvage procedures may be necessary.

The prompt recognition and treatment of lunate and perilunate injuries is imperative. A delay in diagnosis and treatment is associated with poor outcomes and degenerative changes of the wrist.