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Lunate Fracture
From WikiSM
Other Names
- Lunate Fracture
Background
- Frequency of Lunate fracture is controversial
- This is due to bipartate lunate seen radiographically in addition to Kienbocks Disease[1]
- Represent less than 1% of all carpal fractures
Pathophysiology
- Most common mechanism is axial compression from the Capitate with the wrist in dorsiflexion and ulnar deviation
Risk Factors
- Unknown
Differential Diagnosis
Carpal Bone Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Dorsal swelling, ecchymosis
- Tenderness on exam
Evaluation
Radiographs
- Standard Radiographs Wrist
- Generally sufficient
- May see dorsal or volar translation of the capitate
CT Scan
- Useful to better define fracture configuration
Classification
- Palmar pole
- Distal pole
- Transverse
- Osteochondral
- Transarticular body
Management
Nonoperative
- Need to distinguish whether it is truely an acute fracture, or represents a bipartate patella or Kienbachs Disease
- Careful assessment of Scapholunate Ligament, Lunotriquetral Ligament
- Nondisplaced fractures can be immobilized for 4-6 weeks
- Cast: Short Arm Cast
Operative
- Indications
- Displaced fracture
- Evidence of carpal instability
Return to Play
- Typically 6 weeks
- Operative cases will require clearance from surgeon
Complications
- Kienbocks Disease (Avascular necrosis)
- Scapholunate ligament injury
- Lunotriquetral ligament injury
- Nonunion
- Carpal Instability
- Arthritis
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014
- Apr;39(4):785-91; quiz 791. doi: 10.1016/j.jhsa.2013.10.030. Review. PubMed PMID: 24679911.
