Subacute volar lunate dislocation with multi-ligamentous disruption and anterior interosseous nerve involvement: a case report highlighting the consequences of delayed diagnosis

Abstract

Volar lunate dislocation is an uncommon but severe carpal injury resulting from high-energy trauma, often associated with ligamentous disruption and acute median nerve compression. Delayed presentation increases the risk of chronic carpal instability, avascular necrosis, and persistent neuropathy. A 41-year-old male presented with pain and swelling of the left wrist for 2 weeks following a bike-to-bike road traffic accident. Clinical examination revealed wrist swelling, tenderness over the carpal bones, hypoesthesia over the lateral three and a half digits, and positive Durkan’s and Phalen’s tests suggestive of median nerve compression. Benediction sign, Froment’s sign, and impaired OK sign were noted. Radiographs (PA view) demonstrated volar lunate dislocation. CT scan confirmed volar displacement of the lunate with an associated linear undisplaced fracture at its distal pole. MRI revealed near complete tear of the dorsal intercarpal ligament, scapholunate ligament, and lunotriquetral ligament complex. The patient underwent urgent open reduction, carpal tunnel decompression, repair of disrupted intercarpal ligaments, and temporary K-wire stabilization. Postoperative immobilization was followed by supervised rehabilitation. At follow-up, the patient demonstrated improved wrist alignment and progressive recovery of median nerve symptoms. Volar lunate dislocation with associated ligamentous disruption and median neuropathy represents a surgical emergency. Early recognition with advanced imaging and timely surgical intervention are essential to restore carpal stability and prevent long-term complications.