Partial necrosis of the lunate after a translunate palmar perilunate fracture dislocation

Abstract

We present an extreme rare case of traumatic partial avascular necrosis of the lunate after palmar perilunate dislocation with lunate fracture. A 32-year-old female was injured by motorcycle accident with palmar perilunate fracture dislocation and lunate fracture. Scapholunate and lunotriquetrum dislocations were reduced and fixed temporarily. The torn dorsal ligament was repaired. Considering close observation with both arthroscopy and fluoroscopy, we decided not to conduct open reduction and internal fixation for the lunate. Partial avascular necrosis of the lunate appeared gradually in follow-up.

Fig. 1

Injury posterioanterior (PA) (a) and lateral (b) radiographs of the left wrist demonstrating the palmar perilunate dislocation, the radial styloid fracture and an increased scapholunate interval.

Fig. 2

Sagittal computed tomography scan demonstrating volar pole fracture of the lunate (arrow).

Fig. 3

Postoperative PA (a) and lateral (b) radiographs demonstrating fixation of scapholunate interval, lunotriquetral interval and radial styloid.

Fig. 4

Magnetic resonance imaging demonstrating very low signal intensity on T1 weighted image (a) and relative low signal intensity on T2 weighted image (b) at the volar fragment. Arrow, volar fragment; arrowhead, micro Mitek anchor.

Fig. 5

One-year postoperative PA (a) and lateral (b) radiographs demonstrating a relative increase in radiodensity and collapse of the volar fragment (arrow).