Neglected Isolated Lunate Dislocation in a Polytrauma Patient Presenting as Acute Carpal Tunnel Syndrome - A Case Report with Review of Literature.

Abstract

Introduction: Lunate dislocations are uncommon high-energy wrist injuries often missed during initial evaluation in polytrauma settings.

Case report: We present a case of a 40-year-old polytrauma patient who sustained multiple injuries following a road traffic accident. His acute injuries were predominantly treated, while a neglected isolated lunate dislocation remained undiagnosed. Three weeks later, the patient presented with acute carpal tunnel symptoms - severe wrist pain, numbness, and weakness in the distribution of the median nerve.Physical examination demonstrated tenderness over the volar wrist, reduced range of motion, and a positively elicited Phalen's and Tinel's sign. Radiographs and nerve conduction studies confirmed a neglected volar lunate dislocation causing compression of the carpal tunnel. Surgical intervention was performed through a combined dorsal and volar approach. Open reduction and internal fixation were followed by decompressive carpal tunnel release.Postoperatively, the patient recovered well, with resolution of symptoms and return of nearly normal wrist motion and grip strength at 1-year follow-up.

Conclusion: This case underscores the importance of evaluating peripheral joints in polytrauma and shows that even delayed lunate dislocations presenting with carpal tunnel syndrome can be successfully treated using a dual approach without any salvage procedure up to 3 months.