Saberi Sadegh, Arabzadeh Aidin, Farhoud Amir Reza
Orthopaedic Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran.
Trauma Mon. 2016 May 1;21(2):e22378. doi: 10.5812/traumamon.22378. eCollection 2016 May.
Lunate fracture is a rare injury. Most reports are associated with other wrist injuries such as perilunate dislocation and distal radius fracture. Isolated lunate fracture has been reported even more rarely. The choice of treatment and outcomes are consequently undetermined.
In this case report we will describe a lunate avulsion fracture as an isolated injury after a fall from nine meters treated operatively by excision of the comminuted avulsed fragment. After 33 months of follow-up radiographs showed no sign of degenerative joint disorder on simple X-ray, but slight Volar Intercalated Segment Instability (VISI) by a capitolunate angle of 26 degrees was noted. Clinically, the patient was pain free near full wrist and forearm range of motion and could perform his previous vocational and recreational tasks without any limitations.
Despite apparently good short and mid-term clinical outcome, slight volar intercalated segment instability after 33 months of follow-up revealed that lunotriquetral ligament function was probably lost, which led to static instability. This ligament injury may be missed primarily. Excision of the avulsed osteochondral fragment should be the last option of treatment and most attempts should be tried to fix and/or restore the normal anatomy of ligamentous structure.
月骨骨折是一种罕见的损伤。大多数报道都与其他腕部损伤相关，如月骨周围脱位和桡骨远端骨折。孤立性月骨骨折的报道更为罕见。因此，治疗方法的选择和预后尚不确定。
在本病例报告中，我们将描述一例从九米高处坠落导致的孤立性月骨撕脱骨折，通过手术切除粉碎的撕脱碎片进行治疗。经过33个月的随访，普通X线片显示无关节退变迹象，但通过头月角26度观察到轻微的掌侧插入节段不稳定（VISI）。临床上，患者腕关节和前臂接近全范围活动时无疼痛，能够毫无限制地完成之前的职业和娱乐活动。
尽管短期和中期临床结果明显良好，但随访33个月后出现的轻微掌侧插入节段不稳定表明月三角韧带功能可能丧失，导致静态不稳定。这种韧带损伤可能最初被漏诊。切除撕脱的骨软骨碎片应是最后的治疗选择，应尽最大努力固定和/或恢复韧带结构的正常解剖。
