Palmar lunate dislocation with Tran scaphoid fracture dislocation and trapezium fracture-A case report of rare fracture presentation

Abstract

Peri lunate and lunate dislocations are rare injuries associated with high energy impacts on a hyperextended and outstretched wrist. One-fourth (of peri lunate dislocations are missed at the initial presentation. We report a case of volar lunate dislocation along with proximal pole scaphoid and trapezium fracture in a patient who presented with high energy trauma. After the initial reduction of the dislocated lunate, he underwent open reduction internal fixation and soft tissue repair using through volar and dorsal approach. This was followed by K-wire removal and aggressive physiotherapy activities. At the end of three months he regained full movements with no recurrence of dislocation. Overall Peri lunate/lunate dislocation are one of the most important differential diagnosis in high energy injuries which requires immediate attention to prevent the potential risk of avascular necrosis of lunate, scaphoid leading to secondary osteoarthritis. As the injury transitions occurs from a dorsal peri lunate to a palmer lunate pattern, the most likely mechanism involved is a sheer fracture of the proximal pole of the scaphoid by the dorsal lip of the distal radius.

Keywords

• Avascular necrosis
• Carpal injuries
• Volar/dorsal approach
• Wrist injuries
• Carpal instability