Lunate Fracture

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The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

Phalanges

The phalanges of the hand are the group of small bones that comprise the bony core of the digits of the hand. Even though the phalanges are small in size, they are classified as long bones because of their structural characteristics; each phalanx consists of a shaft, distal head, and a proximal base.

Metacarpal bones

A metacarpus is a group of five bones of the hand between the phalanges and the carpus. Even though the metacarpal bones are small, they are classified as long bones since they have structural characteristics of long bones; each metacarpal bone consists of a shaft, distal head, and a wide proximal base.

Carpal bones

The carpus is the anatomical term for the wrist which connects the radius and ulna of the forearm with the metacarpal bones of the hand. It is comprised of eight individual carpal bones that are seated in two neat rows of four. The proximal row of carpal bones, as seen in a lateral to medial direction on the palmar surface, include the scaphoid bone, lunate bone, triquetral bone, and pisiform bone.

The hand generally includes a total of eight carpals. These tiny bones comprise the wrist area between the bones of the forearm and the phalanges or fingers of the hand. The lunate bone is one of the eight carpal bones and is located in the row nearest to the radius and the ulna. The lunate bone touches four other carpal bones, which are the scaphoid, the capitate, the hamate, and the triquetral bones.

A lunate fracture occurs when a crack exists anywhere on the lunate bone. This type of injury can happen as the result of direct trauma or a fall, as many people are inclined to brace themselves with their hands during a fall. A fracture of this bone can be very painful and slow to heal, and delayed diagnosis and treatment may lead to a condition known as osteonecrosis, which is essentially the death of bone tissue that leads to weakening or failure of the bone itself.

Causes & Symptoms of a Lunate Fracture

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A lunate fracture can be caused the same way as for any other type of carpal fracture, including:

  • Traumatic events – A lunate fracture may be caused by a traumatic pressure or force on the wrist, such as while falling down on an outstretched hand with the index finger side of the hand downwards, especially with the wrist in an extended position. Furthermore, if the force is beyond the tolerance power of the bone then this can result in cracking of the lunate bone resulting in a rupture.
  • Vehicle accidents – Vehicle collisions can cause the carpal bones to break, sometimes into several pieces, and often require surgical repair.
  • Sports activities – If you participate in a sporting event such as skiing, soccer, basketball, or rugby, you may be at a higher risk of breaking the lunate bone.

Certain symptoms of a lunate fracture can vary from person to person. In some patients, the fracture may cause little to no pain, while in others, it may cause an immense amount of pain. Therefore, the following symptoms below are associated with lunate fractures:

  • Tenderness – There will be a tender sensation when you attempt to touch the middle of your injured wrist.
  • Swelling – There may be some visible swelling on the fractured area.
  • Pain – Pain is normally the very first symptom to occur. The pain may vary, but most people can experience pain with a fracture. This pain will be located on the middle side of your wrist.
  • Limited mobility – You will have trouble when attempting to grab on a lot of things with your injured wrist, with a limited amount of motion.

Who gets a Lunate Fracture?

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Lunate fractures are not always the result of falling onto an outstretched hand. Therefore, other risk factors may play a role in developing the condition, such as:

 

Age

In cases of younger patients, there is a period during which bones have grown longer due to growth spurts, however, the bone mineral density hasn’t yet caught up. These can leave the newly-grown bones much more vulnerable to fractures. For older adults, they are at a higher risk of a fractured wrist as hormone levels shift and bone mineral density begins to decrease (degeneration), which is the same mechanism that leads to osteoporosis.

Gender

Women are more prone to experiencing a fractured lunate bone once they reach 50 years old, thus doubling the risk every 10 years. For men, the onset of age-related is much later, around the age of 80.

Occupational laborers

Working in occupations that require you to climb and/or operate machinery can put you at an increased risk of breaking your carpal bones.

Sports

Athletes who participate in sports that involve potential falls, such as skiing, soccer, or rugby, are also at a higher risk of a lunate fracture.

How Does a Lunate Fracture Affect You? How Serious is it?

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If you experience a severe level of a lunate fracture, surgical treatment is required and is done in instances where the lunate bone has fully ruptured to a degree where it cannot be rectified by any treatment. This specific technique is known as open reduction. Surgery for a lunate fracture is quite difficult as the lunate bone is small and often requires pins and screws to be precisely stabilized.

Certain complications with or without surgery are quite rare, however, they include the following:

  • Ongoing stiffness – Stiffness, pain, or aching in the affected wrist normally relieves itself eventually after you have been treated with a cast or after surgery. But you may have permanent stiffness or pain if you leave your fractured lunate bone untreated.
  • Nerve or blood vessel damage – Trauma to the wrist can injure adjacent nerves and blood vessels. It is required to seek immediate medical attention if you experience numbness or circulation problems.
  • Osteoarthritis – Fractures that extend into a joint can cause arthritis years later.

Recommended Treatment & Rehabilitation for a Lunate Fracture

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During a diagnosis of a lunate fracture, a physician will perform a regular diagnostic process, which includes a complete medical history, physical exam, and imaging tests. Your physician will begin by asking you for a detailed description of your current symptoms, how they began to take effect, and what triggered them. Next, he or she will examine your wrist and forearm for any dislocation or discoloration. Your doctor may also test your wrist or ask you to perform hand or wrist movements.

Further imaging tests may be ordered to increase the chance of getting a clearer diagnosis for your fractured lunate bone. Some of these tests include:

  • Computed Tomography (CT) scan – CT scans can uncover wrist fractures that X-rays usually miss. Injuries to soft tissues and blood vessels can be seen on CT scans.
  • Magnetic Resonance Imaging (MRI) – Using radio waves and a powerful magnet to produce detailed images of bone and soft tissues, MRIs are much more sensitive than X-rays and can identify very small fractures and ligament injuries.

After a diagnosis has been successfully done, physiotherapy may be further advised. A physiotherapist will work with you following a lunate fracture to help regain regular wrist motion, strength, and function, and will provide education and training to help you prevent any future injuries. Therefore, while your bone heals, your arm will be equipped in a cast or sling to keep it still and promote healing.

During that time, it is important to ensure that the arm does not get too stiff, weak, or swollen. Depending on the amount of activity that is allowed for your type of fracture, your physiotherapist will prescribe gentle exercises to keep your shoulder, elbow, and fingers moving while you are in the cast or sling.

After your cast is removed, your wrist will most likely feel very stiff, and your arm will feel weaker. Therefore, your therapist will examine your wrist, and design a treatment plan specific to your condition and goals to improve its function and restore strength to your arm. Your treatment will include:

 

Pain management

Your physiotherapist will help you identify and avoid painful movements, and show you how to correct abnormal postures to reduce stress on the wrist. He or she will recommend resting the wrist short-term and applying ice to the area to help alleviate the pain. Your therapist may also apply a wrist brace to restrict wrist movement.

Manual therapy

Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and wrist stretches to get your wrist moving properly.

Range-of-motion exercises

You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.

Strengthening exercises

Your physiotherapist will determine which strengthening exercises are perfect for you, depending on your specific areas of weakness. Therefore, your therapist will design an individualized home-exercise program to meet your needs and goals.

Patient education

Depending on the activities you plan on continuing, your physiotherapist will teach you different ways to perform actions, while protecting your wrist and hand. For instance, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.

 

Below are some examples of exercises for you to try. The exercises may be recommended to reduce symptoms linked to a lunate fracture:

 

Wrist flexion and extension

Place your forearm on a table, with your hand and affected wrist extended beyond the table, palm down. Next, bend your wrist to move your hand upward and allow your hand to close into a fist, then lower your hand and allow your fingers to relax. Hold each position for 6 seconds, then repeat 8-12 times a day.

Wrist radial and ulnar deviation

Hold your affected hand out in front of you, palm down. Slowly bend your wrist as far as you can from side to side. Hold each position for 6 seconds, then repeat 8-12 times a day.

Hand flips

While seated, place your forearm and affected wrist on your thigh, palm down. Flip your hand over so the back of your hand rests on your thigh and your palm is up. Alternate between palm up and palm down while keeping your forearm on your thigh. Repeat this method 8-12 times a day.

Wrist extensor stretch

Extend your arm with the affected wrist in front of you and point your fingers toward the floor. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times a day.

Wrist flexor stretch

Extend the arm with the affected wrist in front of you with your palm facing away from your body. Then, bend back your wrist, pointing your hand up toward the ceiling. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15-30 seconds. Repeat this exercise 2-4 times a day.

Alternative & Homeopathic Treatment for a Lunate Fracture

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If you experience mild symptoms of a fractured lunate bone, you may be able to ease your symptoms with a set of homeopathic treatments. Here are a few home remedies you can try to help recover from a lunate fracture:

 

Take breaks from repetitive activities

Whether you are typing, playing guitar, or using a hand drill, try setting a timer beforehand for 15 minutes. When it goes off, stop what you’re doing and wiggle your fingers. Stretch your hands and move your wrists to help improve blood flow to these areas.

Rest

If you ever find yourself straining or forcing tasks such as writing, typing, or using a cash register, relax your grip or reduce the force you are using. Try using a soft-grip pen or tapping keys more lightly.

Stay warm

Keeping your wrist and hands warm can help with pain and stiffness. Consider wearing a fingerless glove or keeping hand warmers nearby.

Non-steroidal anti-inflammatory medications (NSAIDs)

Medications such as ibuprofen, can help reduce further swelling and inflammation.