Perilunate Injury Combined with Lunate Fracture

Hyun-Soo Park; Sung-Jae Kim; Sung-Bae Park; Kwang-Hyun Lee

doi:10.12790/jkssh.2017.22.2.117

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Park, Kim, Park, and Lee: Perilunate Injury Combined with Lunate Fracture

Case Report

Journal of the Korean Society for Surgery of the Hand 2017; 22(2): 117-121.

Published online: 22 June 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.2.117

Perilunate Injury Combined with Lunate Fracture

Hyun-Soo Park¹, Sung-Jae Kim², Sung-Bae Park¹, Kwang-Hyun Lee³

¹Department of Orthopedic Surgery, Hanil General Hospital, Seoul, Korea.

²Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.

³Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea.

Correspondence to: Kwang-Hyun Lee. Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. TEL: +82-2-2290-8485, FAX: +82-2-2299-3774, leegh@hanyang.ac.kr

Received 30 October 2016 Revised 7 March 2017 Accepted 22 March 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present an atypical case of combined comminuted lunate fracture and the scaphoid waist fracture, chip fracture of triquetrum and pisiform. Comminuted scaphoid waist fracture was caused by forced hyperextension of the wrist, similar mechanism to stage I of progressive perilunate instability (PLI), and lunate fracture might be caused by axial compression force, does not appear on the original theory of PLI. We performed closed reduction and screw fixation for the scaphoid fracture and immobilized and mildly distracted the wrist joint with the use of a bridging external fixator to prevent further collapse of comminuted lunate by neutralizing the compression force imposed by the capitate on the lunate. We achieved excellent radiological and clinical outcomes at 29-months of follow-up. We aimed to introduce this rare injury and clinically important points in its treatment with the review of the literature.

Keywords: Perilunate injury, Scaphoid fracture, Lunate fracture

Figures and Tables

Fig. 1

(A) Initial posteroanterior view of simple radiographs revealed waist fracture of the scaphoid. (B) Suspicious fracture line was observed at volar aspect of the lunate on lateral view.

Fig. 2

Initial computed tomography revealed comminuted scaphoid waist fracture with dorsal comminution (A). Coronal fracture on volar portion of the lunate was observed with central depression (B). Dorsal chip bone avulsion fractures (arrow) were observed on the triquetrum (C) and the pisiform (D).

Fig. 3

Last follow-up simple radiographs showed union of the scaphoid fracture and normal alignment of the midcarpal joint (A). Last follow-up computed tomography showed complete union of the scahoid (B) and the lunate fractures (C).

Notes

^{CONFLICT OF INTEREST} No potential conflict of interest relevant to this article was reported.

References

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3. Bain GI, McLean JM, Turner PC, Sood A, Pourgiezis N. Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept. J Hand Surg Am. 2008; 33:1770–1776.

4. Briseno MR, Yao J. Lunate fractures in the face of a perilunate injury: an uncommon and easily missed injury pattern. J Hand Surg Am. 2012; 37:63–67.

5. Takase K, Yamamoto K. Unusual combined scaphoid and lunate fracture of the wrist: a case report. J Hand Surg Am. 2006; 31:414–417.

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