Lunate fractures and perilunate injuries
- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
While not common, lunate fractures and perilunate injuries have important potential consequences. They are most often sustained from a fall onto an extended wrist or some other wrist hyperextension injury.
This topic will review fractures of the lunate and ligamentous injuries of the perilunate region of the wrist, including sprains of the scapholunate and lunotriquetral ligaments, perilunate wrist instability, and perilunate fracture-dislocations. A general overview of wrist pain and carpal fractures, as well as topics devoted to other specific carpal fractures in adults, are presented separately. (See "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "Overview of carpal fractures" and "Scaphoid fractures".)
Hand fractures are among the most common of the extremity injuries, accounting for about 18 percent of all fractures. Carpal bone fractures comprise upwards of 8 percent of hand fractures [1,2]. Fractures to bones of the proximal row–comprising the scaphoid, lunate, triquetrum and pisiform–are most frequent. Lunate fractures are relatively uncommon, representing about 4 percent of all carpal bone injuries [1-4].
Perilunate dislocations and fracture-dislocations are relatively uncommon injury patterns in acute wrist trauma. Perilunate instability represents about 7 percent of all injuries to the carpus . When dislocation occurs in the wrist, it is typically perilunate, meaning that the bones surrounding the lunate lose their continuity with the lunate through disruption of the ligaments. Usually this involves the capitate dislocating dorsally. Perilunate dislocations with an associated fracture were twice as prevalent as those without fracture in the largest published series .
Perilunate sprains can occur in the absence of fracture or dislocation, and involve partial disruption of ligaments joining the lunate to the scaphoid (most commonly), capitate, or triquetrum. Scapholunate sprains represent about 5 percent of acute wrist injuries .
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- CLINICAL ANATOMY AND BIOMECHANICS
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC EVALUATION
- Plain radiographs
- Stress radiographs
- CT and MRI
- DIFFERENTIAL DIAGNOSIS
- Distal radius fracture
- Fracture of the scaphoid, triquetrum, capitate, or other carpal bones
- Kienböck's disease of the lunate
- Wrist sprain
- INDICATIONS FOR SURGICAL REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- RECOMMENDATIONS FOR RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS