Treatments for acute and old distal radius fracture with lunate dislocation.

PURPOSE: Our study was undertaken to determine the correct treatment protocol for distal radius fracture with lunate anterior dislocation.
METHODS: From 2000 to 2007, 58 patients (36 with acute injury and 22 with old injury) with distal radius fracture with lunate anterior dislocation were enrolled in the study. Among acute injury patients, 15 were treated through manipulative reduction and plaster fixation and 21 were treated through minimal invasive poking reduction followed by Kirschner wire and plaster fixation. Among old injury patients, 8 underwent operative reduction of lunate dislocation through the palmar approach and Kirschner wire and plaster fixation, whereas 14 patients underwent operative reduction and fixation through the dorsal approach combined with reparation of the dorsal radiolunate ligament. Lidstrom wrist function scores and the morbidity of lunate necrosis and osteoarthritis were documented and evaluated.
RESULTS: Lidstrom wrist function scores revealed that the rate of excellent and good scores was higher in acute injury patients than in old injury patients (91.7 versus 54.5%, respectively; P = 0.018). The lunate necrosis rate was lower in acute injury patients than in old injury patients (0 versus 27.2%, respectively; P = 0.027). For old injury patients, the lunate necrosis rate was higher in those treated with the palmar approach than in those treated with the dorsal approach (50 versus 14.3%, respectively; P = 0.033).
CONCLUSIONS: The key points for resolving distal radius fracture with lunate dislocation are prompt and precise diagnosis and treatment of lunate dislocation to prevent old lunate dislocation. We recommend that the surgical procedure is performed through the dorsal approach with reparation of the dorsal radiolunate ligament.