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The aim of this study was to analyse lunate fractures and any associated osseo-ligamentous injuries. A systematic review identified 34 cases. We identified carpal instabilities at the radiocarpal and midcarpal joints in volar and dorsal directions. Radiocarpal instabilities (10/34) were usually dorsoradial (8/10), with a transverse lunate fracture, best seen on a coronal image. Midcarpal instabilities (24/34) were usually volar (14/18), with a volar lunate shear fracture, best seen on a sagittal image. Instabilities were sub-classified into non-displaced, subluxated and dislocated. Associated fractures of the scaphoid and the radial and ulnar styloid processes were common. Lunate fractures without subluxation or dislocation had good outcomes with cast immobilization or fixation of associated fractures. Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures. Lunate fracture-dislocations are complex injuries, requiring stabilization of the lunate, associated fractures and ligament injuries; complications are common and acute or delayed salvage procedures may be required.

Atlantoaxial subluxation is a rare condition and requires a high index of suspicion to diagnose and treat in order to avoid long-term sequelae. Here, we present a case of late presentation of a nontraumatic rotatory subluxation of the atlantoaxial joint or atlantoaxial rotatory subluxation. A 17-year-old girl presented 3 months after the onset of nonspecific upper limb sensory symptoms which eventually settled spontaneously. Initial conservative management by the general practitioner had no effect. Computed tomography scanning revealed a Type 1 dislocation with rotatory fixation and with <3 mm anterior displacement of the atlas. The management of Type 1 subluxations is usually conservative with bed rest, oral nonsteroidal anti-inflammatory drugs, muscle relaxants, reduction (if required) and immobilization with a soft collar. This patient, however, required more invasive management due to the late presentation and slightly greater fixed deformity. As the subluxation could not be reduced with active manipulation, Gardner-Wells tongs with traction were applied. She then progressed to a pinned HALO, cyber neck support and subsequently an aspen collar which was eventually weaned off over a few weeks. The outcome and radiologic alignment at follow-up was satisfactory.

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