# 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.

## Key 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.