Open perilunate injury with lunate revascularization after complete ligamentous avulsion

Abstract

Perilunate dislocations are a devastating injury to the carpus that carry a guarded long-term prognosis. Mayfield type 4 perilunate dislocations are rare, high-energy injuries that carry a risk for avascular necrosis (AVN) of the lunate. When AVN ensues and the carpus collapses, primary treatment with a proximal row carpectomy or arthrodesis has been advocated. This case reports a successful clinical result and revascularization of an extruded lunate with open reduction and internal fixation. This type 4, Gustilo grade 1 open perilunate dislocation exhibited complete avulsion of all lunate ligamentous attachments. Management included open reduction and internal fixation as well as carpal tunnel release through a combined dorsal and volar approach. Despite concerns for lunate AVN due to complete disruption of lunate vascularity, a 10-month postoperative clinical and radiographic examination demonstrated no pain with activities of daily living as well as a revascularized lunate.

Open Perilunate Fracture Dislocation with Lunate Extrusion: A Case Report and Literature Review

“…Besides the need for initial debridement and antibiotic coverage, treatment of open PLD/PLFD is similar to their closed equivalents, with definitive primary fixation plus ligamentous repair being advised, unless major soft tissue injury is present [1-3, 26, 27]. In the 2 previous reports of open lunate extrusions [9,14], 1 patient underwent PRC, while the other was subjected to a successful ORIF. As in our case, infectious complications did not occur.…”

“…Rarely, the lunate migrates volarly with complete ligamentous detachment and impaired vascularization, greatly increasing the risk of avascular necrosis (AVN) [6]. Few reports in the literature describe well-defined lunate extrusion or enucleation [7][8][9][10][11][12][13][14][15][16][17], of which only 2 were open injuries [9,14]. We present a case of an open Mayfield type 4 PLFD with lunate extrusion through the volar skin.…”

Diagnostik und Therapie perilunärer Luxationen und Luxationsfrakturen

“…Eine posttraumatische Lunatumnekrose findet sich entgegen den Erwartungen verhältnismäßig selten und zwar am ehesten nach einer kompletten palmaren Luxation (Stadium IV/3, "Enukleation") bei ca. 1 % der Verletzungen [31,32]…”

Trans-scaphoid lunate dislocation: A case series

“…Stage 1 begins with scaphoid rotation and disruption of the scapholunate ligament with stage 4 culminating in complete dislocation of the lunate and disruption of associated ligamentous structures [ 1 ]. Stage 4 injuries are associated with significant morbidity including increased risk of lunate AVN and complete carpal collapse [ 2 ]. Vascular supply to the lunate is maintained by palmar and dorsal vessels; complete dislocation can disrupt the tenuous blood supply leading to AVN [ 2 ].…”