Acute lunate fractures and translunate dislocations

Lunate fractures and translunate fracture dislocations are rare and a high degree of suspicion is required to achieve an early diagnosis. With CT scans, we can achieve a better understanding of the complexity of the injury and therefore appropriate management. Complex carpal dislocations can be classified by the arc of injury. The arcs include the greater, lesser, translunate, and inferior arcs. In addition there are the axial instabilities. The intra-lunate arc injuries can be subclassified based on the level (midcarpal or radiocarpal), direction (dorsal or volar), and severity of the instability (reduced, subluxation, and dislocation). The principles of management of the translunate injuries are to stabilize the lunate keystone first, and then fix the greater arc injuries and finally the lesser arc injuries. If the injury is very severe or the diagnosis has been delayed, a salvage procedure may be a preferred option.