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

• Scaphoid fracture
• Lunate fracture
• Triquetrum fracture
• Pisiform fracture
• Trapezium fracture
• Trapezoid fracture
• Capitate fracture
• Hamate fracture

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

Immobilization

• Thumb spica splint

Disposition

• Discharge with referral to orthopedic surgery

See Also

• Carpal fractures