Middle third most common broad arm sling to support limb for 2 weeks or until comfortable. Diagnosis and management of scaphoid fractures american. Apr 06, 2018 a lunate dislocation is a rare case of traumatic wrist injury which must be attended immediately and repaired with proper lunate dislocation surgery. The proximal row, laterally to medially, consists of the scaphoid, lunate, triquetrum and pisiform. Mar 18, 2015 the lunate is one of these eight carpal bones. Sep 23, 2016 most commonly, a fracture occurs at the narrowest part of the scaphoid known as the waist. Spectrum of carpal dislocations and fracture dislocations. Project overview powerpoint presentation 5 mins for use in the emergency department to promote the new resource at staff meetings.
Know its causes, symptoms, signs, treatment, exercises. Transscaphoid perilunate dislocation radiology case. A fracture to the lunate may also be associated with injury to the tfcc. As the lunate fracture was undisplaced, it was managed conservatively. Management of suspected scaphoid fracture clear injury and positive exam with normal xrays immobilize for 7 10 days thumb spica best.
These eight bones are arranged into two rows with four bones in each. Perilunate dislocations and fracture dislocations are complex injuries to the small bones of the wrist. Jun 04, 2018 broken wrist is often caused by falling down on an outstretched hand in order to break a fall. May 01, 2016 lunate fracture actually is a rare occurrence and makes up 0. Spectrum of carpal dislocations and fracturedislocations. Closed reduction and splinting is more effective with perilunate dislocations and less so with lunate dislocations because of the extent of ligamentous damage. The cost for the early mri approach appears to be equivocal, but there have been no.
No evidence to support figure of 8 bandage or brace. They are most often sustained from a fall onto an extended wrist or some other wrist hyperextension injury. So, there is a risk that if you have a fracture in this area, it can sometimes stop the blood supply to part of the scaphoid bone, leaving part of the bone without a blood supply. Factors predictive of this complication include smoking, longer time elapsed since the fracture, and avascular necrosis avn of the proximal fragment. The distal row, going in the same direction, consists of the trapezium, trapezoid, capitate and hamate. Transient vascular compromise of the lunate after fracturedislocation or dislocation of the. The lunate bone articulates with the scaphoid, the distal radius, and the tfcc. Because the other carpal bones overlap the lunate bone, a fracture may be difficult to identify on plain radiographs and may require ct or mri to confirm. It is supplied by a proximal carpal vascular arcade volarly and dorsally. Management, and outcomes of lunate and perilunate dislocations.
Pdf evaluation, management, and outcomes of lunate and. Note how the radiolunate joint is a little widened but remains aligned. Sep 26, 2019 nonunion is the most common complication after scaphoid fracture treatment, and it may occur in as many as 510% of cases despite proper treatment. The lunate articulates laterally with the scaphoid. A computed tomography scan confirmed the distal radius fracture in addition to an undisplaced fracture of the lunate. Several reports in the literature described lunate fracture in association with distal radius and or other carpal bones fracture especially perilunate fracture dislocations, yet isolated lunate fracture is really a rare reported injury 59. Place these posters in your clinical areas as a visual reminder of the resources available. Seminar on scaphoid and lunate fractures moderator. These small bones, called the carpal bones, comprise eight separate bones, each about the size of a sugar cube, wedged between the end of the forearm and the long bones of the hand. Ct confirms the findings seen on the plain films, and better delineates the multiple small fragments at the scaphoid fracture. Associated fractures of the scaphoid and the radial and ulnar. Lunate dislocationcausessymptomstreatmentrepairbraces. The radiographs were of concern due to an apparent fracture of the lunate.
Delayed avascular necrosis and fragmentation of the lunate. We propose a morphological classification of diepunch fractures that includes five types. Evaluation, management, and outcomes of lunate and. Its symptoms include sudden pain immediately after injury, bruising, tenderness etc. Oct 21, 2016 a diepunch fracture is a depression fracture of the lunate fossa of the distal radius. Currentconceptsin diagnosisandmanagement alisonkitay,md,scottw. Scaphoid fracture introduction anatomy biomechanics mechanism of injury. The lunate is one of the eight carpal bones located in the wrist. Childhood fracture management education powerpoint presentation 30. The rest of the carpal bones are in a normal anatomic position in relation to the radius. This type of fracture occurs most often after a fall onto an outstretched hand. Hamate fracture the hook or the body of the hamate bone may be fractured. He denies systemic symptoms, history of trauma, or recent weight loss. However, mistaking a bipartite lunate for a fracture will not lead to underdiagnosis.
Recent studies gay et al evaluated the use of a simple capitate osteotomy without arthrodesis, through a dorsal medial approach and fixed with staples, in 11 patients with mild forms stage i to iiia, lichtman classification of kienboc. It is an important structure in the middle of the wrist and is critical for painless and full wrist motion. Transient vascular compromise of the lunate after fracturedislocation or. Evaluation, management, and outcomes of lunate and perilunate. A very common ligament injured during a wrist sprain is the scapholunate ligament. Lunate fracture radiographic findings of fracture, tenderness to lunate scapholunate.
These carpals are arranged in two rows, and the lunate is located in the row closest to the radius and ulna. Lunate fracture in an amateur soccer player journal of. The prognosis for lunate fractures is usually good, with radiographic healing and return of function as the norm. Sep 27, 2019 kienbock disease is a condition of uncertain etiology that results in osteonecrosis of the carpal lunate. Midcarpal instabilities 2434 were usually volar 1418, with a volar lunate shear fracture, best seen on a sagittal image. It revealed a central transverse fracture of the lunate with a depressed fragment seen centrally, with some comminution. Nonoperative management can produce inferior results, with. Wolfe,md injuries to the scapholunate joint are the most frequent cause of carpal instability and account for a considerable degree of wrist dysfunction, lost time from work, and interference with activities. Pdf lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation.
Isolated lunate fractures are rare, usually occurring in association with other carpal injuries after a fall on an outstretched hand. Because of the unstable nature of the distal radius fracture, open reduction and internal fixation was performed. A potential pitfall in the diagnosis of lunate fractures is the bipartite lunate, although this entity is very rare. Lateral oblique as for all fractures of the carpal bones, lunate fractures are frequently difficult to diagnose on plain radiography, and injuries will be missed if this modality alone is used to exclude a fracture. Instabilities were subclassified into nondisplaced, subluxated and dislocated. A scaphoid fracture is a break in one of the small bones of the wrist. Leeosterman md, in fractures and injuries of the distal radius and carpus, 2009. Perilunate sprains can occur in the absence of fracture or dislocation, and involve partial disruption of ligaments joining the lunate to the scaphoid most commonly, capitate, or triquetrum. Taljanovic1 scalcione lr, gimber lh, ho am, johnston ss, sheppard je, taljanovic ms 1department of medical imaging, the university of. Pdf arthroscopic management of volar lunate facet fractures. While not common, lunate fractures and perilunate injuries have important potential consequences. Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair.
This is where the blood supply enters the scaphoid bone. Treatment is thumb spica splint and orthopedic follow. To evaluate the extent of the fracture, a computed tomography scan was completed. Jun 12, 2015 nonoperative management can produce inferior results, with. This ligament is in the middle of the wrist between the scaphoid and lunate bones.
Lunate dislocation results in displacement of rotation of lunate without causing any change in the position of other carpal bones. The lunate is attached to the scaphoid and triquetrum via interosseous ligaments. The radiographs of 112 diepunch fractures treated between january. Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. Distally, it is articulates with the convex head of the capitate. Lunate fractures orthopaedicsone articles orthopaedicsone. Lunate fractures and associated radiocarpal and midcarpal. Lunate stress test done in those symptomatic patients with normal mri. Although the main indication for arif of a distal radius fracture is an intraarticular stepoff of more than 1 mm, arthroscopy is particularly useful in the management of unstable or displaced intraarticular fractures as well as comminuted articular.
New classification of lunate fossa fractures of the distal radius. Like the scaphoid bone, the lunate also has a tenuous retrograde blood supply off of an interosseus arterial branch, and it has the same inherent risk of poor healing and avn. Hand xray pa and lateral views mrict may be required to identify occult fractures. When it is injured, the scapholunate ligament can be just stretched, causing instability, or may be completely torn. Know the causes, symptoms, treatment, repair and prevention of lunate dislocation. Management of suspected scaphoid fracture clear injury and positive exam with normal xrays. Scapholunate sprains represent about 5 percent of acute wrist injuries 7. Jan 05, 2016 a potential pitfall in the diagnosis of lunate fractures is the bipartite lunate, although this entity is very rare.