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Lunate dislocation
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Lunate dislocation

Contributors: Derek T. Schloemann MD, MPHS, Danielle Wilbur MD
Other Resources UpToDate PubMed

Synopsis

Causes / typical injury mechanism: Lunate dislocation arises as a result of trauma, typically axial loading with wrist extension, supination, and ulnar deviation following a fall, motor vehicle collision, or sports injury. It is important to maintain a high index of suspicion for this injury in high-energy trauma and also to ensure that adequate imaging is obtained, as this injury is often missed.

Classic history and presentation: Lunate dislocation presents as pain over the palmar or dorsal wrist and may be associated with stiffness and deformity. Delayed diagnosis may occur in up to 25% of cases. Approximately 10% of cases involve open injuries, and 26% occur in the setting of polytrauma.

The typical patient is an individual with a history of trauma from a fall, motor vehicle collision, or sports injury with associated examination findings and x-rays showing perilunate dislocation or lunate dislocation.

Grade / classification system (if any):
The Mayfield classification is used to stage the injury.
  • Stage I injury may show a widened scapholunate interval due to either a disrupted scapholunate ligament or transscaphoid fracture.
  • Stage II injury presents with dorsal dislocation of the capitate (due to lunocapitate articulation disruption) as well as the findings seen in stage I injury.
  • Stage III injury presents with overlap of the triquetrum on the lunate (due to lunotriquetral ligament disruption).
  • Stage IV injury presents as lunate dislocation (due to circumferential disruption of the ligamentous attachments of the lunate).

Codes

ICD10CM:
S63.096A – Other dislocation of unspecified wrist and hand, initial encounter

SNOMEDCT:
110029007 – Traumatic dislocation of lunate bone

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Scaphoid or other carpal fracture without dislocation
  • Distal radius fracture
  • Metacarpal fracture
  • Flexor tendon rupture
  • Extensor tendon rupture
  • Carpal tunnel syndrome
  • Radiocarpal dislocation
  • Avascular necrosis of the lunate (Kienböck disease)
  • Scapholunate advanced collapse (SLAC) wrist
  • Scaphoid nonunion advanced collapse (SNAC) wrist

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:08/27/2020
Last Updated:08/27/2020
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Lunate dislocation
Lunate dislocation : Wrist pain
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