Surgical Treatment of an Isolated Fresh Lunate Fracture. Case Report of a Rare Injury and Review of Literature
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SURGERY
Surgical Treatment of an Isolated Fresh Lunate Fracture. Case Report of a Rare Injury and Review of Literature Pradyumna Raval 1
&
Pravin Patil 1 & Sameer Singh 1
Accepted: 28 July 2020 # Springer Nature Switzerland AG 2020
Abstract A 45-year-old right-handed female presented with a history of fall on an outstretched hand. Initial radiographs revealed a lunate fracture, which was confirmed as an isolated fracture on a computed tomography scan. Internal fixation was performed using a headless micro Acutrak screw (ACUMED), via a volar approach. Radiological union was evident by 8 weeks. At the final followup in 6 months, the patient had a good clinical outcome with a successful return to normal activities. Keywords Isolated . Fresh . Lunate . Fracture . Volar
Introduction Lunate fractures are extremely rare injuries with a reported incidence of 1 to 6.5% [1, 2]. These injuries are associated with other carpal injuries and commonly caused due to high energy trauma [2]. Isolated lunate fractures are often missed and it has been postulated as a cause of Kienbock disease [3, 4]. Isolated transverse lunate fracture is a very rare injury with only one prior reported case of a 3-month-old fracture which was treated surgically using a combined dorsal and volar approach [5]. The authors present a previously undocumented and rare case of an isolated fresh lunate fracture which was treated surgically using a headless cannulated micro screw via an extended volar approach.
Case Presentation A 43-year-old right-hand-dominant female employed as an office worker sustained a closed injury to her right hand after falling down on an outstretched extremity from a This article is part of the Topical Collection on Surgery * Pradyumna Raval [email protected] 1
Department of Trauma & Orthopaedics, Bedford Hospital, Kempston Street, Bedford MK42 9DJ, UK
flight of 3 stairs. She presented to the accident and emergency department with a swollen right hand. On clinical examination, there was ecchymosis on the palmar aspect and tenderness on palpation. Range of movement was restricted due to pain. She was administered appropriate analgesia, and the right forearm and hand was placed into a slab. This patient had a previous history of angina and was on glyceryl trinitrate for the same. Other medications were statin, anti-hypertensive and aspirin. She had previously undergone a tonsillectomy. There were no allergies reported. Standard postero-anterior and lateral radiographs diagnosed a lunate fracture (Figs. 1, 2). Computed tomography (CT) scan confirmed the diagnosis and also that it was an isolated bony injury (Figs. 3, 4). The operative procedure was performed via an extended volar approach to the forearm and hand. Tourniquet was applied to the right arm and elevated to 250 mm of mercury. The transverse carpal ligament was incised, and median nerve was isolated and retracted radially. A ‘V’ capsulotomy was performed to expose the carpal bones. No ligamentous injury was identified, and isolated lunate fracture was confirme
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