Simultaneous distal radius and lunate fractures: a lesson for an unwary eye

Abstract

Simultaneous distal radius and carpus fractures are uncommon. They can be missed because of a diffused clinical picture and an inexperienced clinician reviewing the patient and radiographs. A 64-year-old woman presented to the emergency department (ED) with a clinically deformed left wrist after a fall. Plain radiographs were interpreted as a distal radius intra-articular fracture with volar angulation, both by the ED physician and the first on call for trauma and orthopaedics (T&O). Review of the radiographs in the trauma meeting revealed the possibility of an additional undisplaced lunate fracture. A computed tomography scan confirmed the distal radius fracture in addition to an undisplaced fracture of the lunate. Because of the unstable nature of the distal radius fracture, open reduction and internal fixation was performed. As the lunate fracture was undisplaced, it was managed conservatively. The patient was discharged home the next day and has been doing well at follow-up.

Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review

“…Teisen and Hjarbaek (1988) produced a descriptive classification of lunate fractures, based on the radiological appearance of 17 acute fractures, and the vascularity of the lunate as described by Gelberman and Menon (1980). Before and since then, there have only been small series of acute lunate fractures described (Akane et al, 2014;Amaravati et al, 2005;Asano and Hidaka, 2014;Bain et al, 2008;Briseño and Yao, 2012;Buijze and Mudgal, 2011;Cetti et al, 1982;Christodoulou et al, 1999;Conway et al, 1989;Enoki et al, 2008;Freeland and Ahmad, 2003;Hofmeister and Faruqui, 2009;Hsu and Hsu, 2011;Imbuldeniya and Compson, 2011;Kearsey and Shahzad, 2011;Khattak et al, 2010;Lavelle et al, 2008;Masmejean et al, 1998;Mason et al, 1986;Milliez et al, 1993;Møller, 1983;Nierkens and van der Heijden, 2013;Noble and Lamb, 1979;Pan et al, 2000;Patel and Boardman, 2005;Ran et al, 2009;Ruijters and Kortmann, 1988;Shin and Shin, 2014;Takase and Yamamoto, 2006;Toft et al, 1985;Vasireddy and Lowdon, 2009).…”