Two-stage surgical management for chronic volar lunate dislocation: a case report

TL;DR

A two-stage surgical approach successfully treated a long-term wrist injury that did not respond to conventional methods.

Contribution

A novel two-stage surgical protocol for chronic volar lunate dislocations is presented and shown to be effective.

Findings

A two-stage surgical protocol restored carpal alignment and preserved wrist mobility in a chronic case.

The patient showed excellent clinical recovery one year after the procedure.

The approach successfully addressed challenges of extreme chronicity where standard methods failed.

Abstract

Volar lunate dislocations typically result from high-energy trauma involving dorsiflexion and ulnar deviation forces, and are frequently accompanied by peri-lunate fractures. Without timely intervention, these injuries often progress to a chronic stage, conventionally defined as presentation beyond 6 weeks. Conventional single-stage surgical approaches often yield suboptimal outcomes for such complex, chronic presentations.

We report a 34-year-old male with persistent right wrist pain and restricted mobility for 11 months following a fall. Diagnostic imaging confirmed severe chronic volar lunate dislocation. A two-stage surgical protocol—comprising preoperative progressive wrist distraction followed by open reduction, internal fixation, and ligament reconstruction—successfully restored carpal alignment while preserving a functional range of motion. At one-year follow-up, the patient demonstrated excellent clinical recovery.

This case demonstrates that for severe chronic volar lunate dislocations of exceptionally long duration, a two-stage strategy incorporating progressive distraction and subsequent reconstruction is a viable and effective approach. It successfully addressed the challenges of extreme chronicity, achieving anatomical reduction and functional recovery where standard methods might fail.

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