Alonso-Tejero Diego, Luengo-Alonso Gonzalo, Jiménez-Díaz Verónica, García-Lamas Lorena, Porras-Moreno Miguel Ángel, Cecilia-López David
Department of Orthopedic Surgery, Hospital 12 de Octubre, Madrid, Spain.
Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain.
Strategies Trauma Limb Reconstr. 2022 Jan-Apr;17(1):59-62. doi: 10.5005/jp-journals-10080-1543.
Isolated dorsal lunate dislocation is a rare injury. Only one case has been reported previously in which the treatment was performed in the chronic stage. In this report, we present the case of a 49-year-old handworker male who presented a dorsal dislocation of the lunate after a traffic accident. He was referred to our clinic 2.5 months later due to an initial misdiagnosis. Surgical treatment was performed and consisted of an open reduction using a nerve-sparing dorsal approach. A complete rupture of the perilunate ligaments and a marked instability of the lunate were detected. Stabilisation of the scapholunate, lunotriquetral and scaphocapitate spaces with a compression screw and Kirschner wires, respectively, was performed. The persistence of pain and functional limitation after the surgery along with an insufficient reduction of the scapholunate space on the X-ray and the development of a fistula on the ulnar edge of the carpus prompted reintervention. A hardware-free total wrist arthrodesis was preferred over other procedures, such as proximal row carpectomy, owing to the important articular damage. At the 3-month follow-up, he was clinically stable, consolidation of arthrodesis was documented and he had returned to his previous activities. Isolated dorsal dislocation of the lunate is a rare lesion. There is no consensus on the management of isolated chronic dislocations of the lunate. The frequent delay in the diagnosis compromises the final outcome of reconstructive techniques and introduces the risk of residual instability, increasing the incidence of chronic pain associated with post-traumatic osteoarthritis. In the case of chronic lesions, treatment with palliative techniques, such as proximal carpectomy or joint arthrodesis, should be considered.
Alonso-Tejero D, Luengo-Alonso G, Jiménez-Díaz V, . Chronic Isolated Dorsal Dislocation of the Lunate. A Rare Presentation of Carpal Instability. Strategies Trauma Limb Reconstr 2022;17(1):59-62.
孤立性月骨背侧脱位是一种罕见的损伤。此前仅报道过1例在慢性期进行治疗的病例。在本报告中，我们介绍了1例49岁男性体力劳动者，他在交通事故后出现月骨背侧脱位。由于最初误诊，2.5个月后他被转诊至我们的诊所。进行了手术治疗，采用保留神经的背侧入路进行切开复位。发现月周韧带完全断裂，月骨明显不稳定。分别用加压螺钉和克氏针稳定舟月、月三角和舟头关节间隙。术后疼痛持续存在且功能受限，同时X线显示舟月关节间隙复位不足，腕骨尺侧边缘出现瘘管，促使再次干预。由于关节损伤严重，与其他手术（如近排腕骨切除术）相比，我们更倾向于采用无植入物的全腕关节融合术。在3个月的随访中，他临床稳定，关节融合已愈合，并且已恢复到之前的活动状态。孤立性月骨背侧脱位是一种罕见的损伤。对于孤立性月骨慢性脱位的治疗尚无共识。诊断的频繁延迟会影响重建技术的最终结果，并带来残留不稳定的风险，增加与创伤后骨关节炎相关的慢性疼痛的发生率。对于慢性损伤，应考虑采用姑息性技术进行治疗，如近排腕骨切除术或关节融合术。
阿隆索 - 特赫罗D，卢恩戈 - 阿隆索G，希门尼斯 - 迪亚兹V，等。月骨慢性孤立性背侧脱位。腕关节不稳定的罕见表现。创伤肢体重建策略2022；17(1)：59 - 62。
