Surgical Management of Neglected Lunate Injuries: A Series of Three Cases on Proximal Row Carpectomy

Neglected lunate injuries, including fractures and dislocations, can lead to severe complications such as Avascular Necrosis (AVN) (Kienböck’s disease), chronic carpal instability, and Scapholunate Advanced Collapse (SLAC) wrist. These conditions often result in persistent pain, functional impairment, and progressive arthritis. Proximal Row Carpectomy (PRC) has emerged as a reliable, motion preserving surgical option for managing advanced lunate pathology, especially in resource limited settings. This case series evaluates the clinical and functional outcomes of PRC in patients with neglected or chronic lunate injuries. The case series reports on three patients (two males, one female; age range: 18-56 years) with chronic lunate collapse of varying aetiologies, including two with neglected lunate fractures and one with advanced Kienböck’s disease (Stage III). All patients presented with persistent wrist pain, restricted motion, and imaging evidence of lunate fragmentation or AVN. Surgical intervention involved excision of the scaphoid, lunate, and triquetrum, with preservation of the radioscaphocapitate ligament, allowing capitate articulation with the lunate facet of the radius. Postoperatively, patients underwent structured physiotherapy focusing on Range Of Motion (ROM) and grip strength restoration. All three patients reported significant pain relief within 6-8 weeks postoperatively, with mean Visual Analog Score (VAS) improving from 8 preoperatively to approximately 2.5 at final follow-up. Functional wrist motion was preserved at 50-60% of the contralateral side, with dorsiflexion ranging from 30° to 40° and palmar flexion from 35° to 45°. Radial and ulnar deviation were maintained within functional limits. Grip strength, although reduced compared to the unaffected hand, allowed return to daily activities without major limitations. Radiological evaluation confirmed stable radiocapitate articulation without progressive degenerative changes during the follow-up period. PRC is an effective, economical, and technically straightforward option for neglected lunate injuries, offering a good balance between pain relief and preservation of wrist mobility. While early diagnosis remains essential to prevent irreversible damage, PRC provides favourable outcomes even in delayed presentations, provided that severe radiocapitate arthritis is absent. Larger studies with long-term follow-up are warranted to validate these findings.