Open lunate dislocation: A rare clinical case

Abstract text (incl. references and figure legends)

Case history
A 55 years old male with dyslipidemia, medicated with atorvastatin, was victim from a car crush after work, on his way home.

Clinical findings
The patient presented on emergency room with a large wound on wrist's volar side. Additionally, he complained about numbness on median hand"s territory.

Investigation/Results
Wrist X-ray and CT showed a lunate dislocation and radius styloid fracture. The patient went to operating theater and intraoperatively we found out lunate present on wound"s subcutaneous tissue.

Diagnosis
The diagnosis of open lunate dislocation plus radius styloid fracture was made.

Therapy and Progression
The patient was submitted to irrigation, debridement, open reduction and internal fixation with 4 K wires and carpal tunnel release.
On immediate postoperative period patient had fingers" active mobility intact, with a normal capillary refill, without paresthesias on the thumb and improved numbness on the rest of the fingers. Patient was then transferred to insurance company hospital. The K-wires were left in place for 4 weeks and begun a rehabilitation program after that.
The patient went back to our institution 8 months after surgery, lost on follow-up, complaining of wrist pain. QuickDASH score was 11. On wrist x-ray lunate was dislocated. Wrist arthrodesis was proposed to symptom relief. Although, patient refused, once his wrist mobility was vital to his labor.

Comments
Lunate dislocation is a rare condition related to high energy trauma events. Open lesion is even rarer and prognosis is worst. A correct diagnosis, prompt treatment and a thorough follow-up are essential to minimize complications. Despite the correct treatment, there is a high risk of further complications.

References
Wu X et al. Treatments for acute and old distal radius fracture with lunate dislocation. Eur J Orthop Surg Traumatol.2013.23(2):191–6
Muppavarapu R, Capo J. Perilunate Dislocationsand Fracture Dislocations. Hand Clin.2015.31(3):399-408

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