Perilunate Dislocations

Fisher, Nina; Bi, Andrew S; Tolla, Jadie E De

doi:10.2106/jbjs.rvw.22.00106

Cited by 3 publications

(8 citation statements)

References 50 publications

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“…In a follow-up article specifically describing nondislocated variant injuries in 2013, Herzberg offered an expanded classification system, which includes PLIND pattern injuries in order to capture this emerging subcategory of injuries and to raise index of suspicion for this complex injury pattern. 1 2 4…”

Section: Discussionmentioning

confidence: 99%

Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury

Visser,

Borusiewicz,

Payatakes

2024

J Wrist Surg

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Background Perilunate injuries pose a significant treatment challenge, particularly when initially missed or underestimated. These injuries have a multitude of variations as propagation of the injury may be through ligaments and/or bone, with more recent appreciation given to nondislocated perilunate injuries. Case Description We present a new variant of perilunate injuries, not dislocated (PLIND). This occult ligamentous perilunate injury was associated with ulnar carpal translocation, radiocarpal subluxation, and distal radioulnar subluxation. The extent of injury was fully appreciated intraoperatively, with only subtle clues present on preoperative exam and imaging, emphasizing the high index of suspicion required to identify these injuries. Clinical outcome at 1-year follow-up was very satisfactory. Literature Review PLIND consist a distinct subset within the spectrum of perilunate injuries in which there is no observed disruption of the capitolunate relationship. Based on few cases reported in the literature (attributable to their rare occurrence and likely additional lack of awareness surrounding the injury pattern), current recommendations for surgical management include arthroscopic or open approach to appropriately address osseous and ligamentous injuries. Clinical Relevance Recognition of PLIND injuries is challenging given the lack of frank dislocation of the capitate head on the lunate, as observed in classic perilunate injuries. Heightened clinical suspicion in patients with consistent mechanism and presentation, followed by timely surgical management, may limit sequelae of persistent instability and arthritis. Our case contributed to relevant literature by presenting a previously undescribed PLIND variant combined with radiocarpal instability, ulnar carpal translocation, and distal radioulnar subluxation.

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Section: Discussionmentioning

confidence: 99%

Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury

Visser,

Borusiewicz,

Payatakes

2024

J Wrist Surg

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“…However, the population studied largely consisted of polytrauma patients in which DSP fixation occurred in a delayed fashion at 19 ± 36 days after the inciting event in comparison to ORIF with casting occurring within 3 ± 5 days [ 5 ]. Persistent unreduced dislocations generally warrant salvage procedures to achieve satisfactory outcomes, although recent studies have debated this [ 3 , 8 , 16 ]. DSP use in PLDs in the more acute setting has yet to be reported.…”

Section: Discussionmentioning

confidence: 99%

“…Perilunate injuries are uncommon wrist pathologies that usually arise in young adults after high-energy trauma, such as falls from significant heights or motor vehicle collisions [ 1–8 ]. Despite their severity, diagnosis of these lesions is missed up to 25% of the time [ 1 , 3 , 6–8 ]. These injuries warrant acute care as they can lead to posttraumatic osteoarthritis, dysfunction of the median nerve, avascular necrosis, chronic carpal instability, or loss of range of motion [ 1 , 7–9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Mayfield staging was initially presented in 1980 and detailed the predictable pathomechanical process of sequential ligamentous rupture and joint disruption that occurs in perilunate injury progression ( Table 1 ) [ 1 , 3 , 4 , 10 , 11 ]. The most severe stage IV perilunate injuries, or lunate dislocations (LD), commonly occur volarly into the space of Poirier [ 3 , 6 , 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most accepted initial management principles for perilunate injuries often involve emergent closed reduction, neurovascular monitoring, and definitive surgery within three to five days [ 1 , 3–5 , 11 ]. Surgery includes open reduction and internal fixation (ORIF) of any bony injuries followed by soft tissue ligamentous repairs as necessary [ 1 , 3–5 , 11 ]. Popular methods to achieve a stable fixation involve the use of K-wires, screws, or cerclage wires, followed by cast immobilization [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Dorsal spanning plate fixation in perilunate injuries: a case report

Jain,

Harder,

Rounds

et al. 2024

Case Reports in Plastic Surgery and Hand Surgery

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Medium-Term Patient-Reported Outcomes after Surgical Management of Perilunate Injury: A Multiinstitutional Experience

Gabig,

Payne,

Whitsett

et al. 2024

J Wrist Surg

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Background There is a lack of consensus on the optimal treatment of perilunate injuries (PLIs). Open reduction with internal fixation with scapholunate (SL) ligament repair is recommended; however, procedures such as lunotriquetral (LT) ligament repair, carpal tunnel release (CTR), proximal row carpectomy, denervation, and arthrodesis may also be used. Purpose The purpose of this study was to assess patient-reported outcomes (PROs) after surgical management of PLIs. Methods A retrospective review of surgically treated PLIs at two institutions in a major metropolitan city from 2014 to 2020 was conducted. Demographics, radiographic data, and details of surgical management were reviewed. PROs were prospectively collected and analyzed. Results Eighty-seven patients with surgically managed PLIs were identified. The average time to surgery was 4 ± 7days. Twenty-six percent of patients presented with acute median neuropathy. Thirty-seven patients provided PROs for analysis. Patient-Rated Wrist Evaluation scores were 22 ± 12.9, 14.4 ± 11.3, and 37 ± 22 for pain, function, and total scores, respectively. Satisfaction was 7 ± 3 Sixteen percent of patients were unable to maintain employment due to their injury. The interval to return to work was 6.3 ± 7.7 months. Conclusion PLIs cause significant morbidity and affect patients' ability to return to work. While open reduction with SL repair is routinely performed to treat PLIs, additional procedures may be considered. Undergoing concurrent CTR in the absence of neurological symptoms showed no differences in outcomes. Level of Evidence Level III, retrospective cohort study.

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Perilunate Dislocations

Cited by 3 publications

References 50 publications

Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury

Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury

Dorsal spanning plate fixation in perilunate injuries: a case report

Medium-Term Patient-Reported Outcomes after Surgical Management of Perilunate Injury: A Multiinstitutional Experience

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