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UNCLASSIFIEDSECTORAL IMPACTED FRACTURE OF THE LUNATE BONE: A

CASE REPORT.

Borovic Eduard, PhD, Ass. Prof., Pavlovschi Ecaterina

National Scientific - Practice Center of Emergency Medicine (Moldova)

Corresponding Autor:

Eduard Borovic, M.D., PhD.

GSM: +373 79476290

E-mail:[email protected]

Summary.Unclassified sectoral impacted fracture of the lunate bone: a case report.

It is described a clinical case of sectoral impacted fracture of the lunate bone. The

specific of the trauma and the results of the subjective examination of the patient, in congruence

with the primary imagistic picture, need an additional attention of the emergency orthopedic

doctors.

Key words: fracture, lunate, trauma, patient

Introduction.

Lunate fractures are rare, and often they are difficult to diagnose. Lunate fractures occur

in 1.1% of the general population (2, 3). Isolated lunate fractures secondary to direct impact are

uncommon; they can be classified into 5 types (7). Teisen Classification: tip 1 - volar pole; tip 2 -

chip fracture; tip 3 dorsal pole; tip 4 sagittal; tip 5 transverse.The lunate fractures as a

result of a transverse load through the lunate in die-punch fracture (a depression fracture of the

lunate fossa of the distal radius) (6). Lunate fractures, particularly those which are not

recognized early and treated appropriately, may lead to osteonecrosis and chronic wrist pain and

disability. Therefore, to reduce the likelihood of this complication, early detection of lunate

fractures, followed by appropriate management, is paramount (8). Apart from clinical and

radiological assessment, understanding the mechanism of injury is crucial for diagnosing

uncommon wrist fractures and their treatment (2).

Materials & Methods.

We report a 55-year-old woman with a very rare type of fracture - sectoral impacted

fracture of the lunate bone (impacted fracture one in which one fragment is firmly driven intothe other (4)). Mechanism of injury is a fall on the outstretched hand with hyperextension at the
https://www.google.md/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&ved=0CD8QFjAC&url=http%3A%2F%2Fwww.oxforddictionaries.com%2Fdefinition%2Fenglish%2Funclassified&ei=CIDOUpz0C6eJ4ATiw4GICw&usg=AFQjCNGW7VUSEFPunSfEPHoVAUsOS5OVCg&bvm=bv.59026428,d.bGEhttps://www.google.md/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&ved=0CD8QFjAC&url=http%3A%2F%2Fwww.oxforddictionaries.com%2Fdefinition%2Fenglish%2Funclassified&ei=CIDOUpz0C6eJ4ATiw4GICw&usg=AFQjCNGW7VUSEFPunSfEPHoVAUsOS5OVCg&bvm=bv.59026428,d.bGEmailto:[email protected]://www.google.md/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&ved=0CD8QFjAC&url=http%3A%2F%2Fwww.oxforddictionaries.com%2Fdefinition%2Fenglish%2Funclassified&ei=CIDOUpz0C6eJ4ATiw4GICw&usg=AFQjCNGW7VUSEFPunSfEPHoVAUsOS5OVCg&bvm=bv.59026428,d.bGEhttps://www.google.md/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&ved=0CD8QFjAC&url=http%3A%2F%2Fwww.oxforddictionaries.com%2Fdefinition%2Fenglish%2Funclassified&ei=CIDOUpz0C6eJ4ATiw4GICw&usg=AFQjCNGW7VUSEFPunSfEPHoVAUsOS5OVCg&bvm=bv.59026428,d.bGEmailto:[email protected]://www.google.md/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&ved=0CD8QFjAC&url=http%3A%2F%2Fwww.oxforddictionaries.com%2Fdefinition%2Fenglish%2Funclassified&ei=CIDOUpz0C6eJ4ATiw4GICw&usg=AFQjCNGW7VUSEFPunSfEPHoVAUsOS5OVCg&bvm=bv.59026428,d.bGE


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wrist. An important point to determine the nature of the injuries was the presence on the wrist of

a massive metal bracelet watch.

In the department of emergency, the patient complained of mild local pain on the dorsal

surface of the wrist joint. The examination revealed a limited hematoma, localized on the dorsum

of the joint and also an increased pain when trying to do extension movements.

Imaging techniques play an important role in evaluating the complex anatomy of bone of

the wrist. Standard projections for the wrist are postero anterior and lateral views (2). As a result

of X-ray study, the patient had been diagnosed with sectoral impacted fracture of the lunate

bone. This fracture was detected only in the lateral view and its usually difficult to diagnose

(Fig. 1, 2).

Nature of the fracture, apparently, was defined by the presence on the wrist of the metal

bracelet, the edge of which acted as an impactor? Given the age of the patient and given theabsence of a history of site contents on prophylactic therapy in the occurrence of this fracture

does not exclude the role of osteoporosis.

Fig. 1: lateral view Fig. 2: postero anterior view

Immobilization of the fracture was performed using a stabilizing orthosis for wrist.Duration ofimmobilization was 6 weeks.

In order to prevent the development of osteonecrosis and chronic pain in the wrist joint,

was prescribed the following treatment:Clodifen 75 mg daily, to reduce post-traumatic pain, 4

days; D-Calcin for the prevention of post-traumatic osteoporosis, 2000 IU daily; Londromax -

non-hormonal specific inhibitor of osteoclastic bone resorption, 70 mg of the preparation 1 time

per week, nr.4; Ripronat - (in conditions of ischemia it restores the balance between delivery and

cells oxygen demand) 500 mg 2 times daily, 2-3 weeks. The immobilization was followed by

rehabilitation treatment, massage and physiotherapy. Subsequently we will study long-term

effects of injury(Fig. 3, 4).


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Fig. 3, 4:The results of computed tomography after 6 weeks

Results &Conclusion.

Isolated lunate fractures secondary to direct impact are uncommon; they can be classified

into 5 types according to Teisen classification(Fig. 3)

Fig. 3: Teisen Classification (5)

In this article, we report a case of very rare type of fracture, sectoral impacted fracture of the

lunate bone (Fig. 3). This type of fracture is not provided for the above classification and can

claim to independence, despite its casuistry.

Fig. 3: Sectoral impacted fracture of the lunate bone.

Bibliography.1. Bhat A., K. Kumar B.,Acharya A. Radiographic imaging of the wrist. Indian J PlastSurg. 2011;44(2):186196.
http://www.ncbi.nlm.nih.gov/pubmed/?term=Bhat%20AK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Kumar%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Acharya%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Acharya%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Kumar%20B%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bhat%20AK%5Bauth%5D


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2. Chong Yew Ong J., Meldan B. D., OSullivanM. E. Impaction-fracture of the capitateand lunate: a case report. Journal of Orthopaedic Surgery 2012;20(2):243-5

3. Cetti R., Christensen S.E., Reuther K. Fracture of the lunate bone. Hand. 1982;14:80-844. Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders, an imprint ofElsevier, Inc. 2007: 2176 p.

5. Galbraith P. J., Richardson M. L. Fracture of the Lunate: Radiografic Findings and CaseReport. Radiology Case Reports. 2007;2(1):13-16

6. Smithuis R. WristFractures. Radiology Assistant. 2008: http://www. Radiologyassistant. nl/en/p476a23436683b

7. Teisen H, Hjarbaek J. Classification of fresh fractures of the lunate. J HandSurg [Br]. 1988;13:458-462.

8.

Vasireddy A., Lowdon I.

Lunate Fracture in an Amateur Soccer Player. Journal ofOrthopaedic & Sports Physical Therapy. 2009;39(12): 884-884
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