Greater arc injury of the wrist with fractured lunate bone: a case report

Comminuted lunate fracture combined with distal radius fracture and scaphoid fracture: A case report

RATIONALE

Incidence of lunate fractures is very low, less than 1% of all fractures. Lunate fractures generally come from high-energy injuries, often combined with other wrist fractures. Simple lunate fractures can be fixed with screws or Kirschner wires. However, Comminuted lunate fractures are difficult to reduce and fixe by conventional methods.

PATIENT CONCERNS

Here we report a 42-year-old male construction worker who was crushed by an excavator bucket and presented with comminuted lunate fracture combined with distal radius fracture and scaphoid fracture.

DIAGNOSES

Comminuted lunate fracture, distal radius fracture, and scaphoid fracture.

INTERVENTIONS

The posterior approach was used to reconstruct the radial lunate bone with polymethylmethacrylate cement, and cannulated screws were used to fix the scaphoid and distal radius fractures.

OUTCOMES

At the 3rd month after surgery, the movement of the right wrist joint improved. At the sixth month after surgery, the patient returned to the building site and began working at the same intensity as before the injury.

LESSONS

Although the incidence of comminuted lunate fractures is very low, they occur sometimes. For comminuted lunate fractures, early identification and intervention can preserve most of the function of the wrist joint.

Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review

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.

Compression Screw Fixation of Lunate Fracture: Case Report and Review of the Literature

Background  Isolated traumatic lunate fractures without other surgical carpal bone or ligamentous injuries are extremely rare, with few published reports available to guide management. Lunate fracture management is controversial, and depends on concurrent injuries of adjacent carpal bones, ligaments, risk of ischemia, and displacement. Case Description  A 48-year-old right hand dominant man suffered a crush injury to the left hand caught between a forklift and a metal shelf. Radiographs and computed tomography imaging of the left hand and wrist were significant for a displaced Teisen IV fracture of the lunate. A dorsal ligament sparing approach was utilized to access, reduce, and fixate the fracture using a headless compression screw. After immobilization and rehab, at 9 months after initial injury, the patient was back to work on full duty without restriction and pleased with the results of his treatment. Literature Review  A literature review of lunate fracture compression screw fixation was performed and revealed a total of three reports indicating successful treatment of fractures, with patients returning to full activity. Clinical Relevance  Lunate fractures are rare, often missed, and treating these injuries can be challenging, particularly in the setting of acute trauma. Based on our limited experience, we believe that open reduction and internal fixation of isolated Teisen IV lunate fractures with a headless compression screw is a viable treatment modality with satisfactory outcomes.

Arthroscopic Treatment of Translunate Perilunate Injuries, Not Dislocated (PLIND)

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.

Non-dislocation lunate fracture combined with distal radius fracture: A case report

RATIONALE

Lunate fractures are very rare, accounting for only 0.5% to 6.5% of all carpal fractures. They are mostly caused by high-energy trauma and commonly occur with fractures and dislocations of other carpal bones. It is rarely combined with Colles' fracture and the underlying pathogenesis and prognostic significance still remain controversial.

PATIENT CONCERNS

Here we report a case of a fresh lunate fracture combined with Colles' fracture, without dislocations of other carpal bones caused by a low-energy fall injury.

DIAGNOSES

Lunate fracture, Colles' fracture.

INTERVENTIONS

This patient received closed reduction and internal fixation (CRIF) with K-wire.

OUTCOMES

The patient took follow up 1 year and the patient showed good function of the wrist joint LESSONS:: Lunate fractures have no high misdiagnosis rate. Patients suffering persistent wrist swelling after a trauma should be carefully examined and followed up to prevent severe secondary diseases and wrist joint dysfunction.

Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review

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.

Transverse translunate fracture-dislocation: A rare injury

Perilunate fracture-dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture-dislocation. The patient returned to normal activities after 6 months.

Uncommon carpal fractures

Fractures of the hand are frequently encountered with injuries to the phalanges and metacarpals comprising the vast majority. Fractures of the carpal bones excluding the scaphoid, however, are fairly uncommon. Despite the rarity of fractures of the remaining seven carpal bones, they can cause a disproportionate amount of morbidity from missed diagnosis due to their subtlety as well as their frequent association with significant ligamentous disruption or even other carpal bone fractures. Delayed diagnosis can result in inadequate fracture care, which places the wrist at risk of disabling sequelae. This review focuses on the current concepts of pathophysiology, diagnosis, and treatment of carpal fractures other than the scaphoid.

Greater arch injuries

Dislocations and fracture dislocations of carpal bones are uncommon injuries which invariably poses challenges in the management. Perilunate fracture dislocations are the combination of ligamentous and osseous injury that involve the "greater arc" of the perilunate associated instability. Despite their severity, these injuries often go unrecognized in the emergency department leading to delayed diagnosis and treatment. A Prospective study was done from June 2008 to December 2013 in 15 cases of complex wrist injuries which included of greater arch injuries, perilunate fracture dislocation and one dorsal dislocation of Scaphoid. 10 cases of perilunate fracture dislocation underwent open reduction and internal fixation with Herbert screw and k-wire, 4 cases of greater arch injury underwent closed reduction and kwire fixation and one case of neglected dorsal dislocation underwent proximal row carpectomy. One patient had Sudecks osteodystrophy 1 had Scaphoid nonunion and 6 had median nerve compression. Overall outcome according to Mayo wrist score was 53 % excellent, 33 % good and 14 % fair. Greater arch injuries are difficult to treat because injuries to many ligaments are involved and failure to recognize early leads to persistent pain, disability and early onset of arthritis. Prompt recognition requires CT scan and MRI. Management requires reduction and multiple K-Wiring according to merits of the case.

Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures

Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

Transstyloid perilunate fracture-dislocations of the carpus, a review of two cases

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.

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.

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.