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J Wrist Surg
DOI: 10.1055/a-2772-2209
Scientific Article

Traumatic Lunate Fracture Patterns and Outcomes of Treatment

Authors

  • Mehmet Furkan Tunaboylu 

    1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United States

  • Andrew F. Emanuels

    1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United States

  • Ali Gharibi Loron

    2   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States

  • Aida Sarcon

    1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United States

  • Mohamed Morsy

    3   Department of Orthopedics, University of Alabama, Birmingham, Alabama, United States

  • Steven L. Moran

    1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Objective

The purpose of this study was to evaluate the incidence and outcomes of traumatic lunate fractures in a Level I trauma center over a 20-year period.

Background

Traumatic lunate fractures are rare, making it difficult to determine their frequency, outcomes, and patterns in clinical practice.

Materials and Methods

A retrospective evaluation of 57 patients was conducted at a single institution from 2000 to 2022. Imaging studies, including radiographs, computed tomography, and magnetic resonance imaging, were reviewed to confirm traumatic etiology and fracture pattern.

Results

Fifty-seven lunate fractures met inclusion criteria: 11 were isolated and 46 had associated carpal fractures. Treatment included immobilization in 31 patients and surgery in 26. At a mean follow-up of 20.5 months (range, 2–186), average wrist flexion–extension range of motion was 90 degrees (range, 45–160), and grip strength averaged 26 kg (range, 6–48). Patient-reported outcomes were collected at a mean of 105 months (range, 12–226), with mean scores of 27 for the Disabilities of the Arm, Shoulder, and Hand, 19 for the Patient-Rated Wrist Evaluation, and 77 for the Mayo Wrist Score. Complications included 25 cases of posttraumatic arthritis, 2 cases each of avascular necrosis (AVN), nonunion, and complex regional pain syndrome, and 1 hardware infection. Posttraumatic arthritis was more frequently observed in patients with dorsal intercalated segment instability (DISI), age over 50 years, and displaced fractures.

Conclusion

Lunate fractures occur in conjunction with greater arc injuries. Volar pole fractures were the most common fracture type observed. Predictors of long-term osteoarthritis included age over 50 years, DISI deformity, and displaced fractures at the time of diagnosis. Surgical fixation methods resulted in comparable outcomes. Two lunates progressed to AVN, both of which occurred following open operative fixation.

Type of study/level of evidence

Prognostic, Level IV

Keywords

fracture patterns - iatrogenic avascular necrosis - traumatic lunate fractures

Ethical Approval

Approval from our institutional review board was obtained for this retrospective study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.




Publication History

Received: 21 August 2025

Accepted: 12 December 2025

Article published online:
06 January 2026

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