Avascular necrosis of the lunate secondary to perilunate fracture dislocation: Case report and review of the literature

Abstract

This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.

Kienböck Disease following a Single Wrist Traumatic Incident: A Scoping Review

“…While transient vascular impairment to the lunate occurs after dorsal PLD, perilunate fracture–dislocation (PLFD), or volar lunate dislocation (LD); however, subsequent development of Kienböck disease is rare. 12 13 14 15 16 17 18 19 23 24 25 26 27 28…”

“…15 The cumulative data from 23 articles, which included a total of 518 patients with PLD and PLFD, revealed that Kienböck disease was seen in 17 individuals, accounting for 3% of the total. 16…”

“…15 The cumulative data from 23 articles, which included a total of 518 patients with PLD and PLFD, revealed that Kienböck disease was seen in 17 individuals, accounting for 3% of the total. 16 Volar PLD/PLFD and dorsal LD are less frequently occurring injuries compared with dorsal PLD/PLFD and volar LD, respectively. However, because of extensive ligamentous injury, Kienböck disease is a serious concern after volar PLD/PLFD and dorsal LD.…”

“…Ligamentous injury surrounding the lunate may cause an acute interruption of vascular supply and compromise intraosseous circulation of the lunate. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Coll reported a case of palmar dislocation of the scaphoid and lunate, which subsequently resulted in lunate avascular necrosis (AVN). 25 Manohara et al described a case of AVN involving the scaphoid, lunate, and triquetrum following an isolated perilunate dislocation (PLD) of the wrist.…”

“…21,22 While transient vascular impairment to the lunate occurs after dorsal PLD, perilunate fracture-dislocation (PLFD), or volar lunate dislocation (LD); however, subsequent development of Kienböck disease is rare. [12][13][14][15][16][17][18][19][23][24][25][26][27][28] In a review of 206 volar LDs, just two (1%) cases developed Kienböck disease following closed reduction. 12 In a retrospective study of 65 individuals with PLD and PLFD, Israel et al identified two instances (3%) of Kienböck disease.…”