Journal List > J Korean Soc Surg Hand > v.20(1) > 1106507

J Korean Soc Surg Hand. 2015 Mar;20(1):33-38. Korean.
Published online March 31, 2015.  https://doi.org/10.12790/jkssh.2015.20.1.33
Copyright © 2015. The Korean Society for Surgery of the Hand
Carpal Tunnel Syndrome and Rupture of Flexor Tendon Associated from Neglected Anterior Lunate Dislocation
Young Yool Chung, and Young Jae Jang
Department of Orthopaedic Surgery, Gwangju Christian Hospital, Gwangju, Korea.

Correspondence to: Young Yool Chung. Department of Orthopaedic Surgery, Gwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju, Korea. TEL: +82-62-650-5064, FAX: +82-62-650-5066, Email: paedic@chol.com
Received March 15, 2015; Revised March 23, 2015; Accepted March 23, 2015.

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

Anterior dislocation of lunate is rare, it can result in median nerve compression and attritional rupture of flexor tendon when delay diagnosed. We report a patient with second finger flexor tendon rupture and carpal tunnel syndrome caused by neglected anterior lunate dislocation. Patient underwent operative treatment for that excised lunate, released carpal tunnel and reconstructed second flexor tendon using palmaris longus tendon. One year after surgery, fucntional and neurologic symptom were recovered. Also carpal alignment was maintained on plain radiographs, even after excision of the lunate.

Keywords: Neglected; Anterior lunate dislocation; Carpal tunnel syndrome; Flexor tendon rupture

Figures


Fig. 1
Preoperative images of left wrist. (A) Radiograph (anteroposterior view) shows destroyed Gilula line. (B) Radiograph (lateral view) shows lunate dislocated anteriorly to the rest of the carpus. (C) Radiograph (carpal tunnel view) shows narrow carpal canal space-occupied by dislocated lunate (arrow).
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Fig. 2
(A) Magnetic resonance image (MRI) (coronal view) shows third, fourth, fifth flexor tendons are ulnar deviated due to lunate dislocation and discontinuity of second flexor tendon (arrow). (B) MRI images (transverse view) show second flexor digitorum profundus & superficialis (left arrow) has continuity at metacarpabone level but second flexor digitorum profundus & superficialis both is abscent (right arrow) at carpal level. (C) MRI image shows anteriorly dislocated lunate compress the median nerve (arrow).
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Fig. 3
(A) Lunate (arrow) was dislocated anteriorly. (B) Median nerve (arrow) was artrophied by compressive force. (C) second flexor tendon totally ruptured by dislocated lunate. but tendon Sheath (arrow) of second flexor digitorum profundus was remnant state. (D) We excised a dislocated lunate bone. (E) second flexor tendon was repaired using autogenous palmaris longus tendon graft.
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Fig. 4
(A, B) Postoperative radiographs (anteriorposterior view, lateral view) show totally excised lunate bone.
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Fig. 5
(A, B) one year after surgery carpal bone alignment maintained and no other degenerative change obseved on radiographs (anteriorposterior view, lateral view).
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Fig. 6
Index finger has a good active flexion and extension function.
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References
1. Dobyns JH, Linscheid RL, Chao EY, et al. American Academy of Orthopaedic Surgeons. Traumatic instability of the wrist. In: Instructional course lectures. Volume 24. St. Louis: C.V. Mosby; 1975. pp. 182-199.
2. Cara J, Narvaez A, de la Varga V, Guerado E. Median nerve neuropathy from an old lunate dislocation. Acta Orthop Belg 1998;64:100–103.
3. Johnston GH, Bowen CV. Attritional flexor tendon ruptures by an old lunate dislocation. J Hand Surg Am 1988;13:701–703.
4. Cooney WP, Linscheid RL, Dobyns JH. Fractures and dislocations of the wrist. In: Rockwood CA, Green DP, editors. Rockwood and Green's fractures in adults. 6th ed. Philadelphia: Lippincott-Raven; 1996. pp. 745-867.
5. Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980;5:226–241.
6. Neviaser RJ. Proximal row carpectomy for posttraumatic disorders of the carpus. J Hand Surg Am 1983;8:301–305.
7. Russell TB. Inter-carpal dislocations and fracture-dislocations; a review of 59 cases. J Bone Joint Surg Br 1949;31:524–531.
8. Kim DH, Shin JY, Shin KC. The treatment of volar lunate dislocation and perilunar dislocation. J Korean Soc Fract 1995;8:902–907.
9. Kawai H, Yamamoto K, Yamamoto T, Tada K, Kaga K. Excision of the lunate in Kienbock's disease. Results after long-term follow-up. J Bone Joint Surg Br 1988;70:287–292.