Lunate fracture

Background

  • Isolated lunate injuries are rare
  • Occurs via FOOSH mechanism
  • Blood supply enters distal end - proximal fracture fragment at risk of avascular necrosis (Kienbock’s disease)

Clinical Features

  • Tenderness elicited by axial compression applied along 3rd metacarpal

Differential Diagnosis

Carpal fractures

AP view

Evaluation

  • Hand x-ray (PA and lateral views)
  • MRI/CT may be required to identify occult fractures

Management

General Fracture Management

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Immobilization

Disposition

  • Discharge with referral to orthopedic surgery

See Also

References