Shunmugam Meenalochani, Phadnis Joideep, Watts Amy, Bain Gregory I
1 Flinders University, Adelaide, Australia.
2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia.
J Hand Surg Eur Vol. 2018 Jan;43(1):84-92. doi: 10.1177/1753193417740850. Epub 2017 Nov 13.
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.
本研究的目的是分析月骨骨折及任何相关的骨韧带损伤。一项系统评价确定了34例病例。我们在掌侧和背侧方向识别出桡腕关节和腕中关节的腕骨不稳定情况。桡腕关节不稳定（10/34）通常为背桡侧（8/10），伴有横行月骨骨折，在冠状位图像上显示最佳。腕中关节不稳定（24/34）通常为掌侧（14/18），伴有掌侧月骨剪切骨折，在矢状位图像上显示最佳。不稳定情况被进一步分为无移位、半脱位和脱位。舟骨以及桡骨和尺骨茎突的相关骨折很常见。无半脱位或脱位的月骨骨折通过石膏固定或相关骨折的固定可取得良好疗效。月骨骨折半脱位是不稳定损伤，最好通过腕骨骨折固定进行处理。月骨骨折脱位是复杂损伤，需要稳定月骨、相关骨折和韧带损伤；并发症很常见，可能需要进行急性或延迟挽救手术。
