The lunate is a crescent-shaped carpal bone in the central proximal row, articulating with the radius above, the capitate below, the scaphoid laterally and the triquetrum medially. It is the most commonly dislocated carpal bone, typically from a fall on an outstretched hand forcing it anteriorly into the carpal tunnel. Its blood supply enters through palmar and dorsal vessels, and in a minority of people only one source supplies it, which may predispose to Kienbock disease.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Endochondral ossification from a single centre appearing at age 4. |
The lunate is the most commonly dislocated carpal bone, typically following a fall on the outstretched hand that fails the perilunate ligaments progressively from lateral to medial. Perilunate dislocations and lunate dislocations require urgent closed reduction and surgical stabilisation of the carpal ligaments. Kienbock disease is idiopathic avascular necrosis of the lunate producing progressive wrist pain and collapse, associated with negative ulnar variance in some patients. It is staged by the Lichtman system, and early disease with negative ulnar variance may be treated by radial shortening osteotomy to unload the lunate. A Type II lunate, with an extra facet for the hamate, is associated with arthritis at the lunate-hamate articulation.
Avascular necrosis of the lunate causing progressive wrist pain, stiffness, and eventual collapse, more common with a short ulna (negative ulnar variance).
A high-energy hyperextension injury dislocates the carpus around the lunate or the lunate itself into the carpal tunnel, risking acute median nerve compression.
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