Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 331-337
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.331
Lunate dislocation with avulsed triquetral fracture: A case report
Ling-Yi Li, Cheng-Jyh Lin, Chih-Yuan Ko
Ling-Yi Li, Cheng-Jyh Lin, Chih-Yuan Ko, Department of Orthopedic Surgery, China Medical University Hospital, Taichung City 40402, Taiwan
Author contributions: Li LY reviewed the literature and contributed to the writing of the manuscript; Lin CJ analyzed the case and performed the measurements; and Ko CY was responsible for the revision of the manuscript and guided the work including clinical procedure all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chih-Yuan Ko, Doctor, MD, Attending Doctor, Surgeon, Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yude Road, North District, Taichung City 40402, Taiwan. d14333@mail.cmuh.org.tw
Received: July 8, 2021
Peer-review started: July 8, 2021
First decision: October 16, 2021
Revised: October 25, 2021
Accepted: November 26, 2021
Article in press: November 26, 2021
Published online: January 7, 2022
Processing time: 175 Days and 6.5 Hours
Abstract
BACKGROUND

Lunate dislocation is an uncommon traumatic wrist injury that require prompt surgical management. Misdiagnosis or delayed treatment often leads to a poor outcome. Open reduction and surgical repair of disrupted ligaments are done in most cases to prevent long-term joint dysfunction. However, this method has certain limitations that include partial functional improvement, which poses a high risk for degenerative arthritis and wrist instability.

CASE SUMMARY

A 37-year-old man presented to the Emergency Department of our hospital following a motorcycle accident. Physical examination revealed swelling and tenderness of the right hand and wrist. The patient was initially misdiagnosed with a wrist contusion by an emergency physician, but was eventually diagnosed with lunate dislocation associated with a triquetral avulsed fracture, indicated for open reduction and ligament repair. We performed closed reduction and two Kirschner wire fixations following Tavernier’s method. The injured hand was protected with a standard short-arm orthosis for one month. The patient returned to normal daily work without discomfort at five months postoperatively. Encouragingly, there was no lunate necrosis or arthritis in the latest radiologic examinations.

CONCLUSION

This case provides evidence that the closed reduction technique for addressing such cases can reduce soft tissue destruction.

Keywords: Hand trauma; Carpal injury; Lunate dislocation; Triquetral fracture; Closed reduction; Case report

Core Tip: Lunate fracture dislocation is considered urgent open reduction and surgical repair of disrupted ligaments. However, this method still has certain limitations and can raise a high risk for degenerative arthritis and wrist instability. In this case, it provides evidence that closed reduction technique can reduce soft tissue destruction and minimize the risk of post-traumatic sequelae. Surgeons should attempt to try closed reduction before open reduction in such selected cases.