Transscaphoid Dorsal Lunate Dislocation: A Case Presentation and Review of the Literature

Abstract

This case report describes a 74-year-old man with the rare injury of transscaphoid dorsal lunate dislocation (LD). He sustained a crushing injury with a huge amount of energy to his right wrist while working with a pressing machine. There were deep abrasions and areas of skin necrosis on the dorsum of the wrist. The patient was treated with closed reduction and a Herbert screw fixation for the scaphoid fracture. Six months postoperatively, avascular necrosis (AVN) of the lunate and scaphoid was apparent on the wrist radiographs. We offered a proximal row carpectomy to the patient, but he declined surgery because he was able to perform his activity of daily living. Dorsal LD as well as its variants has a high prevalence of AVN of the lunate. Delayed diagnosis, delayed treatment, and open reduction increase the risk of AVN development of the lunate. The level of evidence is therapeutic IV.

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…”

“…31 At surgery, open reduction of PLD/PLFD and LD provide the opportunity to assess the extent of the ligamentous and vascular injuries; however, missed diagnosis, delayed treatment, and volar PLD/PLFD and dorsal LD increase the chance of lunate AVN. 23 There are only a few experiences describing the management of Kienböck disease after a single traumatic incident. However, treatment principles should mirror those used to manage the idiopathic Kienböck disease, as well as addressing any acquired predisposing factors.…”

“…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.…”

“…In addition, there were 2 out of the 14 patients did not have sufficient follow-up to confirm the development of Kienböck disease. 23 Lunate fractures per se are uncommon fractures and are often accompanied by other wrist injuries, especially in cases involving PLFD. In these cases, the term "translunate" is used to fully describe the extent of the injuries.…”