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Solano MA, Morell SM. Suture Anchor Fixation for Lunate Osteochondral Shear Fracture: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00059. [PMID: 37590428 DOI: 10.2106/jbjs.cc.23.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 26-year-old right-hand-dominant man sustained a left transradial, translunate perilunate injury after motor vehicle collision. The proximal lunate fractured a primarily cartilaginous 15 × 15 mm osteochondral shear fragment with 40% articular surface involvement. A novel lunate fracture suture anchor fixation technique is described, which led to fracture healing. The radial styloid was treated with a single screw. CONCLUSION Translunate perilunate injuries involving the lunate proximal articular surface are rare. Treatment recommendations are limited to case reports. Suture anchor fixation led to stable fixation and fracture healing at the final 6-month postoperative follow-up.
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Affiliation(s)
- Mitchell A Solano
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Cievet M, Buffard M, Kumble A, Ramos-Pascual S, Locquet V, Burnier M. Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00114-7. [PMID: 37364729 DOI: 10.1016/j.hansur.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
The purpose of the study was to compare outcomes of fully-arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) to treat acute traumatic lunate fractures. A literature search was conducted using Medline and Embase. Demographic data and outcomes were extracted for included studies. The search identified 2,146 references: 17 articles were included, reporting on 20 cases (4 ARIF and 16 ORIF). No differences between ARIF and ORIF were found in rate of union (100% vs 93%, P = 1.000), grip strength (mean difference, 8%; 95%CI, -16-31; P = 0.592), rate of return to work (100% vs 100%, P = 1.000), or range of motion (mean difference, 28°; 95%CI, -25-80; P = 0.426). Lunate fractures were not identified in 6 of the 19 radiographs, but were identified in all CT scans. There were no differences in outcome between ARIF and ORIF for the treatment of fresh lunate fracture. The authors recommend surgeons to perform CT scans when diagnosing high-energy wrist trauma so as not to overlook lunate fractures. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Maxime Cievet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Clinique Trenel, 575 Rue du Dr Trenel, 69560, Sainte-Colombe, France.
| | - Marius Buffard
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Ankitha Kumble
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Sonia Ramos-Pascual
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
| | - Marion Burnier
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
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Herzberg G, Cievet-Bonfils M, Burnier M. Arthroscopic Treatment of Translunate Perilunate Injuries, Not Dislocated (PLIND). J Wrist Surg 2019; 8:143-146. [PMID: 30941255 PMCID: PMC6443390 DOI: 10.1055/s-0038-1667307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
Background Translunate perilunate dislocations were recently described as well as perilunate injuries, not dislocated (PLIND). The authors present a case of transradial styloid, translunate PLIND which sustained a full arthroscopic reduction and internal fixation. Case Description A 33-year-old man sustained a transradial styloid, translunate PLIND due to a fall from a truck with his wrist in hyperextension. The diagnosis was made at the acute stage. Full arthroscopic reduction and internal fixation with Kirschner wires was performed, followed by a 6 weeks' immobilization period. Uneventful healing of both the lunate and radial styloid were observed at 6 weeks and confirmed with a computed tomography scan. At 4 years of follow-up, the Lyon wrist score was 78% (good). Literature Review Very few lunate fractures are described in the literature. Translunate perilunate dislocations were recently described as well as PLIND. To the best of the authors' knowledge, a case of transradial styloid, translunate PLIND which sustained a full arthroscopic reduction and internal fixation has never been reported so far. Clinical Relevance This case reports a unique pattern of transradial styloid, translunate PLIND and outlines the usefulness of a full arthroscopic treatment. An open reduction for this pattern of injury would have been extensive, difficult, and probably unreliable.
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Affiliation(s)
- Guillaume Herzberg
- Wrist Surgery Unit, Department of Orthopaedics, Claude-Bernard Lyon 1 University, Herriot Hospital, Lyon, France
| | - Maxime Cievet-Bonfils
- Wrist Surgery Unit, Department of Orthopaedics, Claude-Bernard Lyon 1 University, Herriot Hospital, Lyon, France
| | - Marion Burnier
- Wrist Surgery Unit, Department of Orthopaedics, Claude-Bernard Lyon 1 University, Herriot Hospital, Lyon, France
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Shunmugam M, Phadnis J, Watts A, Bain GI. Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review. J Hand Surg Eur Vol 2018; 43:84-92. [PMID: 29132239 DOI: 10.1177/1753193417740850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to analyse lunate fractures and any associated osseo-ligamentous injuries. A systematic review identified 34 cases. We identified carpal instabilities at the radiocarpal and midcarpal joints in volar and dorsal directions. Radiocarpal instabilities (10/34) were usually dorsoradial (8/10), with a transverse lunate fracture, best seen on a coronal image. Midcarpal instabilities (24/34) were usually volar (14/18), with a volar lunate shear fracture, best seen on a sagittal image. Instabilities were sub-classified into non-displaced, subluxated and dislocated. Associated fractures of the scaphoid and the radial and ulnar styloid processes were common. Lunate fractures without subluxation or dislocation had good outcomes with cast immobilization or fixation of associated fractures. Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures. Lunate fracture-dislocations are complex injuries, requiring stabilization of the lunate, associated fractures and ligament injuries; complications are common and acute or delayed salvage procedures may be required.
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Affiliation(s)
- Meenalochani Shunmugam
- 1 Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia
| | - Joideep Phadnis
- 1 Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia.,3 Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, UK
| | - Amy Watts
- 1 Flinders University, Adelaide, Australia
| | - Gregory I Bain
- 1 Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia
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Transstyloid perilunate fracture-dislocations of the carpus, a review of two cases. J Hand Microsurg 2014; 5:30-5. [PMID: 24426669 DOI: 10.1007/s12593-012-0065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
Abstract
Transstyloid perilunate fracture-dislocations of the carpus resulting from a force in an ulnar-to-radial direction are rare injuries. We present two cases of transstyloid perilunate fracture-dislocations of the carpus, one of which dislocated palmarly and was accompanied with fractures of the triquetrum and the ulnar styloid. The treatment algorisms are described and a satisfactory reduction is the goal for optimal functional recovery.
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Abstract
Purpose To review a series of translunate perilunate dislocations to analyze the, mechanism of injury, diagnosis, management, and outcome. Methods A literature review and a survey of the International Wrist Investigators Workshop were performed to locate cases. Results Translunate perilunate injuries are rare. There is a spectrum of severity. The mechanism of injury is usually high-energy, and multiple fractures are the norm. High-energy mechanism, perilunate dislocation, comminuted lunate fracture and delayed presentation greater than 7 days are associated with a higher likelihood of a salvage procedure being required. Discussion Translunate injuries are a complex variant of perilunate dislocations. Early diagnosis is critical in understanding the complexity of the injury. Lunate fixation should be performed prior to bony and ligamentous stabilization of the proximal row. In delayed or highly comminuted cases, salvage procedures are the preferred option. Including a translunate arc in addition to the greater and lesser carpal arc would lead to a more inclusive classification. Level of Evidence Level IV.
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Affiliation(s)
| | - Samuel Pallapati
- Paul Brand Centre of HLRS, Christian Medical Centre, Vellore, India
| | - Kevin Eng
- Department of Orthopaedic Surgery, Modbury Public Hospital, Adelaide, Australia
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Reichel LM, Bell BR, Michnick SM, Reitman CA. Radial styloid fractures. J Hand Surg Am 2012; 37:1726-41. [PMID: 22835591 DOI: 10.1016/j.jhsa.2012.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 02/02/2023]
Abstract
Radial styloid fractures can occur in isolation or in association with other injuries, including complex intra-articular distal radius fractures, carpal fractures, carpal dislocations, and radiocarpal dislocations. The anatomy surrounding the radial styloid is complex, and complications related to surgical approach, treatments, and symptomatic hardware can occur. Operative treatments vary according to the injury pattern present, and pattern recognition is the key to optimizing treatment of these injuries. Outcomes are related to the precision of the reconstruction as well as the magnitude of the injury; better results are associated with lower-energy patterns.
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Affiliation(s)
- Lee M Reichel
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA.
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