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Bilateral Volar Lunate Dislocation with Radial Fracture Associated: a Case Report

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Abstract

Carpal dislocations are a rare condition usually resulting from a high-energy trauma on the hyperextended hand in ulnar deviation. To the best of our knowledge, only 6 cases of bilateral volar lunate dislocation have been reported in literature, and none of them presents with an associated radial fracture. We report a 3-year follow-up of a patient who sustained bilateral volar lunate dislocation with radial fracture associated treated surgically to reduce the fracture and to reconstruct the injured ligaments. A 51-year-old sustained an injury to both wrists in a fall while paragliding. He presented with pain to both wrists and his back. Physical examination showed diffuse swelling in his wrists and tenderness to his lumbar region. A total body CT scan showed L1–L3 vertebral fractures requiring surgical treatment. Wrists radiographic investigation revealed bilateral volar lunate dislocation associated to a right wrist ulnar and radial styloid fracture with radius interposition into the scapho-luno-triquetral articulation. We treated the patient with K-wires and external fixation on the right side and K-wires and a cast on the left side. Three years after treatment the range of motion in the right wrist compared to the left was: 75°/70° of flexion, 70°/65° of extension, 30°/35° of ulnar deviation, 20°/15° of radial deviation, 85°/80° of supination and 80°/70° of pronation. Bilateral perilunate dislocations or fracture dislocations are extremely rare. These patterns of injuries are commonly missed initially, especially in patients with multiple traumas, so the patient may present at a later date with secondary complications. Perilunate carpal dislocation may be treated with closed reduction but may also require open reduction and reconstruction of injured ligaments in order to restore stability and allow return to function. The purpose of this study is to present a rare and frequently misdiagnosed clinical entity, hereupon commonly undertreated resulting in poor long-term results. Prompt diagnosis and treatment is mandatory to allow rapid return to function and to avoid secondary complications.

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Authors and Affiliations

  1. Dipartimento di Emergenza e Accettazione, UOC Ortopedia e Traumatologia d’Urgenza, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italia

    Giulia Pachera, Francesco Tadolini, Stefania Briano, Giacomo Demontis & Federico Santolini

  2. Dipartimento di Scienze Chirurgiche - Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italia

    Lamberto Felli

Authors
  1. Giulia Pachera
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  2. Francesco Tadolini
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  3. Stefania Briano
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  4. Giacomo Demontis
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  5. Federico Santolini
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  6. Lamberto Felli
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All authors reviewed and approved the final version and have agreed to be accountable for all aspects of the work including any issues related to accuracy or integrity.

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Correspondence to Francesco Tadolini.

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Pachera, G., Tadolini, F., Briano, S. et al. Bilateral Volar Lunate Dislocation with Radial Fracture Associated: a Case Report. SN Compr. Clin. Med. 4, 243 (2022). https://doi.org/10.1007/s42399-022-01325-8

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