J Korean Soc Surg Hand.  2017 Jun;22(2):117-121. 10.12790/jkssh.2017.22.2.117.

Perilunate Injury Combined with Lunate Fracture

• Park HS
• Kim SJ
• Park SB
• Lee KH

• KMID: 2383804
• DOI: http://doi.org/10.12790/jkssh.2017.22.2.117

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.

Keyword

Perilunate injury; Scaphoid fracture; Lunate fracture

MeSH Terms

External Fixators
Follow-Up Studies
Wrist
Wrist Joint

Figure

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  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.

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  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).

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  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).

Reference

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