[Palmar lunate dislocation]

Compound Dorsal Dislocation of Lunate with Trapezoid Fracture

We report about a dorsal dislocation of the lunate accompanied by a trapezoid fracture in a 41-year old male patient after a motorcycle accident. The lunate dislocation with no dorsal or volar intercalated segment instability (DISI, VISI) was diagnosed by x-ray whereas the trapezoid fracture was only diagnosable by computed tomography. A closed reduction and internal fixation of the lunate by two Kirschner wires was performed, the trapezoid fracture was conservatively treated. Surgery was followed by immobilization, intense physiotherapy and close follow-up. Even though complaints such as swelling and pain subsided during the course of rehabilitation, partial loss of strength and range of motion remained even after 16 months. In conclusion, a conservative treatment of trapezoid fractures seems to be sufficient in most cases. Closed reduction with K-wire fixation led to an overall satisfactory result in our case. For dorsal lunate dislocations in general, open reduction should be performed when close reduction is unsuccessful or DISI/VISI are observed in radiographs after attempted close reduction.

[Clinical findings and treatment of perilunar dislocations and dislocation fractures]

Perilunate dislocations, dislocation fractures and lunate dislocations are rare injuries predominantly resulting from hyperextension of the wrist during high-energy trauma. Early recognition and treatment of these injuries usually results in good functional outcome despite degenerative changes on radiographs. Immediate reduction and adequate restoration of normal alignment are the key to successful healing. Surgical intervention with open reduction and ligament repair aims at stable reconstruction of the carpus. It requires broad surgical experience and a profound knowledge of normal anatomy.

[Bilateral perilunar fracture luxation in a patient with multiple trauma]

We present the case of a 37-year-old, multiply injured man who sustained a bilateral perilunar fracture dislocation after a 6 m fall. The fracture dislocations were diagnosed by standard radiographs. The right side was initially treated by closed reduction and external fixation, the left side by closed reduction and splint immobilization. The patient received definite treatment 5 days after the initial injury by open reduction and internal fixation using suture anchors and temporary K-wire fixation which were removed after 6 weeks. The patient achieved almost a full range of motion in both hands and went back to his work as a roofer 5 months after surgery.