Classification of fresh fractures of the lunate

Unusual case report of concomitant lunate and scaphoid fractures without associated dislocation in a 16-year-old male

INTRODUCTION AND IMPORTANCE

Lunate fractures without associated dislocations are rare injuries, combination scaphoid-lunate fractures without an associated dislocation are even more rare of which few are reported in the literature.

CASE PRESENTATION

This case report describes a 16-year-old otherwise healthy male with ipsilateral scaphoid and lunate fractures after punching a goalpost with his left hand, for which he had surgical management. This patient had a successful treatment with two headless compression screws through a single extended carpal tunnel approach. Surgery was performed within two weeks of injury after initially immobilized with a thumb spica splint. The postoperative period was complicated by noncompliance with weight-bearing status and missed three-month followup. However, by six months, subsequent visits demonstrated radiographic and clinical healing as well as full wrist range of motion without any other sequelae.

CLINICAL DISCUSSION

This case offers more evidence regarding this rare injury. Lunate fractures and scaphoid fractures can both be treated with open reduction and internal fixation using headless compression screws, however little evidence exists when it comes to treating them in combination.

CONCLUSION

The use of headless compression screws through a single extended carpal tunnel approach led to clinical and radiographic healing in a 16 year-old-male with combined scaphoid and lunate fractures at 6 month follow up.

Delayed union of a pediatric lunate fracture in the United Kingdom: a case report and a review of current concepts of non-scaphoid pediatric carpal fractures

Pediatric carpal fractures are rare and often difficult to detect. This paper reviews the current literature on pediatric non-scaphoid carpal fractures, with a case report of a lunate fracture associated with a distal radius and ulnar styloid fracture, managed nonoperatively in a 12-year-old boy. There is lack of consensus regarding the management of these fractures due to the low number of reported cases. A frequent lack of long-term follow-up limits our understanding of the outcomes, but good outcomes have been reported for both nonoperative and operative management. This case report brings attention to the current time period for the definition of delayed union in pediatric carpal fractures, and emphasizes the need for prolonged follow-up for the detection of delayed complications leading to functional impairment.

Trans-scaphoid trans-lunate trans-triquetral volar perilunate dislocation: A case report

Introduction

Translunate volar perilunate dislocations are extremely rare, with few documented cases. Only eight instances of volar translunate perilunate dislocation have been described in the literature. This report presents a successfully treated case using early reduction and internal fixation that led to a very satisfying outcome at 9 months follow-up.

Case report

A 20-year-old man presented with left wrist pain and swelling after a fall from a vehicle at 50 km/h, landing on an outstretched right hand. Radiographs and a CT scan identified scaphoid, lunate, and triquetral fractures, along with a volar perilunate dislocation. Surgical treatment was performed with a dorsal approach, including scaphoid and lunate fracture fixation, triquetral avulsion repair, and lunate stabilization with K-wires. The wrist was immobilized for 6 weeks, intense physical therapy started after K-wires removal. At 9 months follow-up, positive results were seen clinically and radiologically.

Discussion

A perilunate fracture-dislocation includes dislocation of the carpus from the lunate. Johnson divided these injuries into lesser arc (pure ligamentous) and greater arc (fracture-related). Bain introduced the translunate arc concept in a case series of three patients, depicting a path through the lunate causing lunate fracture alongside perilunate injury. Treatment focuses on lunate reduction and fixation, combined with addressing greater and lesser arc injuries. Achieving successful lunate realignment and fixation is challenging. However, early diagnosis, prompt reduction, rigid fixation, and repair of both arc injuries can lead to optimal functional recovery.

Scaphoid and Carpal Bone Fracture: The Difficult Cases and Approach to Management

Scaphoid and carpal bone fractures are challenging injuries to manage and have significant functional implications. Prompt diagnosis is important and relies on systematic evaluation via history, examination, and imaging. Cross-sectional imaging is often helpful for diagnosis and treatment planning. Treatment for nondisplaced fractures is often closed but these injuries typically require prolonged immobilization and may still result in nonunion or avascular necrosis. Displaced carpal bone fractures, and those associated with carpal instability, typically require open reduction internal fixation.

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.

Suture Anchor Fixation for Lunate Osteochondral Shear Fracture: A Case Report

CASE

A 26-year-old right-hand-dominant man sustained a left transradial, translunate perilunate injury after motor vehicle collision. The proximal lunate fractured a primarily cartilaginous 15 × 15 mm osteochondral shear fragment with 40% articular surface involvement. A novel lunate fracture suture anchor fixation technique is described, which led to fracture healing. The radial styloid was treated with a single screw.

CONCLUSION

Translunate perilunate injuries involving the lunate proximal articular surface are rare. Treatment recommendations are limited to case reports. Suture anchor fixation led to stable fixation and fracture healing at the final 6-month postoperative follow-up.

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.

Hegemann's Disease Detected with a Traumatic Olecranon Fracture: A Case Report

CASE

We describe a case of Hegemann's disease in a 10-year-old boy practicing karate. The disease was discovered by chance when evaluating a traumatic olecranon fracture. Radiography showed not only olecranon fracture but also a shortening of the epiphysis of the humeral trochlea and a segmental lesion with sclerosis. The trochlea lesion was considered asymptomatic Hegemann's disease. After the olecranon healed conservatively, the patient resumed karate activities and underwent follow-up radiography. The trochlea lesion gradually normalized after 2 years without symptoms.

CONCLUSIONS

Regardless of the initial alarming radiographic findings, the lesion gradually healed, and the patient was able to return to sports activities.

Closed Limb Fractures With Compromised Vascularization: A Narrative Review

Vascular compromised fractures typically result in a high rate of healing complications, such as avascular necrosis, nonunion, delayed union, and arthritis, which severely affect a patient's function and quality of life. The purpose of this review was to identify and describe the epidemiology and available treatment options for the most well-known vascular compromised closed fractures. The injuries discussed in detail in this review were scaphoid, lunate, femoral neck, and talar fractures. Current evidence suggests that optimal treatment for vascular compromised fractures is dependent on the degree of fracture displacement and comminution, and the patient's post-injury functional demands, age, and bone quality. Conservative efforts generally include casting or splinting with a period of immobilization. Surgery is indicated for substantially displaced fractures, patients who require higher functional demands and an earlier return to activity, or if complications occur following nonoperative treatment; however, operative intervention is typically performed for femoral neck fractures regardless of the amount of displacement. Various surgical techniques exist, though internal fixation with screws is a common procedure among these injuries and can be used in combination with other implants, such as plating or Kirschner wires (k-wires), when needed. Severe fracture comminution, poor bone quality, or arthritis can contraindicate the use of screws and more invasive intervention will be required. Bone grafting is done in some cases to enhance vascularity. Salvage procedures exist for patients who develop severe complications, but these will permanently alter the anatomy of the injured area and should be considered a last resort.

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.

Impaction-fracture of the capitate and lunate: a case report

We report a 15-year-old girl who underwent a mid-carpal fusion for undiagnosed impaction-fractures of the capitate, lunate, and triquetrum after a fall on her outstretched left hand in a dorsiflexed and radially deviated position. The joint was dis-impacted, and the height of the lunate was restored using a cortical bone graft. The damaged proximal capitate articular surface was decorticated to facilitate fusion, as was the lunotriquetral articulation. Kirschner wires were inserted along the coronal plane. At the one-year follow-up, the patient had achieved a satisfactory range of motion and fusion of the capitate-lunate-triquetral articulations.

Oblique shear fractures of the lunate

Traumatic fractures of the lunate are rare. This article presents two patients who had displaced oblique lunate fractures and distal radius fractures. Both fractures achieved union; however, transient avascular necrosis occurred in the proximal healing of one patient.