Doctors in Training

Lunate dislocations: anatomy, diagnosis and management

Madeleine Garner

Correspondence to: Madeleine Garner;

E-mail Address: [email protected]

Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK

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Branavan Rudran

Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK

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Amir Khan

Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK

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Quen Tang

Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK

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Philip Mathew

Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK

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Published Online:13 Jul 2021https://doi.org/10.12968/hmed.2021.0025

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Abstract

Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.

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2 July 2021Volume 82Issue 7

ISSN (print): 1750-8460
ISSN (online): 1759-7390

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History

Received 11 January 2021

Accepted 22 March 2021

Published online 13 July 2021

Published in print 2 July 2021

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Keywords

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