Volar lunate fracture-dislocations of the wrist: case report for two patients treated with external frame and internal open reduction

Translunate perilunate injuries-a spectrum of this uncommon injury

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.

Total volar extrusion of the lunate and scaphoid proximal pole with concurrent scapholunate dissociation

This article describes a case of a 24-year-old man with a total volar extrusion of the lunate and scaphoid proximal pole with concurrent scapholunate dissociation. The viability of the lunate and the proximal pole of the scaphoid are at high risk in this type of injury. Scaphoid nonunion, avascular necrosis of the lunate and proximal pole of the scaphoid, and carpal instability are inevitable unless the blood supply is restored. Thus, proximal row carpectomy at injury may be an acceptable option to avoid these complications and late sequelae, including chronic wrist pain and dysfunction. However, the authors attempted accurate reduction of the extruded bones and internal fixation.Final radiographs and magnetic resonance imaging 12 years postoperatively showed healing without avascular necrosis. Carpal indices involving the scapholunate angle, radiolunate angle, and carpal height ratio were similar in both wrists without evidence of carpal instability or collapse. Range of motion and grip power were 75% and 76%, respectively, compared with those of the uninjured wrist. Clinical scores showed good results, and the patient reported no pain during activities of daily living and was satisfied with his surgical results. Open reduction and internal fixation can be a viable option in this rare pattern of injury.

Gradual distraction using an external fixator followed by open reduction in the treatment of chronic lunate dislocation

Chronic lunate dislocation is a difficult problem to deal with. We describe a surgical technique whereby gradual wrist distraction is applied using an external fixator followed by open repositioning of the lunate. We have successfully used this technique in a rugby player with an undiagnosed chronic lunate dislocation. Our case was able to return to competitive rugby playing.

Transstyloid, translunate fracture-dislocation of the wrist: case report

Earlier reports have described characteristic fracture-dislocation patterns of the carpus and distal radius. Most result from a fall onto an outstretched arm, with an applied force directed in a radial-to-ulnar direction across the wrist. We present the clinical, radiographic, and arthroscopic findings noted with an unusual pattern of injury resulting from a force applied at the ulnar side of the wrist.