Association Between Lunate Morphology and Carpal Collapse Patterns in Scaphoid Nonunions

Purpose: Type I lunates have a single distal facet for articulation with the capitate; type II lunates have an additional (medial) hamate facet on the distal articular surface. We retrospectively reviewed a series of patients with scaphoid nonunions to determine if there was an association between lunate morphology and the degree of carpal instability observed. Association between lunate morphology and the location of the scaphoid fracture (proximal or waist) was also investigated. Methods: Radiographs were evaluated for 45 patients with established scaphoid nonunions. Lunate morphology, scaphoid fracture location, and radiolunate angle were determined. Results: Type I lunates were present in 21 patients. Of these, 15 were found to have a dorsal intercalated segment instability pattern (radiolunate angle greater than 15°). By contrast, only 4 of the patients with type II lunates exhibited this pattern of instability. No significant association was found between lunate morphology and the scaphoid fracture location. Conclusions: Type II lunate morphology is associated with significantly decreased incidence of dorsal intercalated segment instability (DISI) deformity in cases of established scaphoid nonunion (p = .0002). Lunate morphology, however, was not significantly associated with the location of the scaphoid fracture in these cases (p = .19). Type of study/level of evidence: Prognostic IV.