Lunate and Perilunate Dislocations: Our Experience

Abstract

Purpose: Lunate and perilunate dislocations are uncommon dislocations and diagnosis could be delayed or missed resulting to chronic disability. This study is to document the pattern in our institution. Methods: This was a ten month prospective study, eight patients were studied and information on biodata, mechanism of injury, X-ray findings, duration between injury treatment, treatment and associated injuries were obtained. Four patients with lunate dislocation had open reduction which was through the anterior approach with simultaneous carpal tunnel release. The anterior carpal ligaments sutured were repaired. A below elbow plaster cast was applied with the wrist in about 20 degree of flexion for four weeks. Reduction was by manipulation in three patients with perilunate dislocation. The seven patients treated had physiotherapy for 9-14 weeks except for one that presented 6 weeks after injury. One patient with lunate dislocation left our care when offered open reduction; he presented two weeks after injury. Results: The patients were aged between 26-62 years. The mean±SD age was 39.50±10.95 years. The ratio of Right: Left wrist was 1.7:1. Mechanism of injury was due to high energy traumas from Motor vehicular accident 4/8, fall from height 3/8 and heavy object falling on the wrist. Conclusions: It was noted that lunate and prelunate dislocations were seen mostly in young males and early manipulation or open reduction and subsequent immobilization in plaster of Paris with the wrist in about 20 degree flexion position for four weeks give good functional outcome in these dislocations. Thus prompt diagnosis of these dislocations should be made and appropriate treatment instituted.