Perilunate Dislocations and Transscaphoid Perilunate Fracture–Dislocations: A Retrospective Study With Minimum Ten-Year Follow-Up

Clinical outcomes following reduction and pinning of lesser arc injuries without repair of the scapholunate interosseous ligament

“…They also state that poor reduction results in worse degenerative changes; however, that this does not seem to translate into a poor functional outcome. 11 In our study we achieved anatomic reduction in seven of ten patients with closed manipulation, which is comparable to that of Adkison et al 3 Of these, only one patient showed signs of osteoarthritis on X-ray follow-up and scored fair on the Mayo score with no pain, full range of movement and grip strength 93% compared to the uninjured side. Open treatment of PLDs using dorsal or dorsal and volar combined incisions, for reduction and ligament repair have also shown poor results.…”

“…Trumble et al 25 described combined dorsal and volar approach with repair of the SLIL, protected by a looped interosseous cerclage wire, to give better compression across the SL interval compared to K-wires. 25 This study reported good range of movement and grip strength when compared to the contralateral side and no deterioration of the SL gap or angle over time, in keeping with the work of Forli et al 11 Unfortunately outcomes such as pain, instability or the incidence of osteoarthritis were not assessed and their results were equivocal with regard to return to work and function. In addition, more than half the patients required re-operation in order to remove broken metal-ware.…”

“…11,[17][18][19][20] However there is controversy as to whether to achieve reduction via open or closed means and how to maintain the scapholunate relationship. There is no clear evidence to suggest that open reduction and acute repair of the SLIL is advantageous to closed reduction and pinning alone.…”

“…The SLAC wrist is seen with acceleration of the post-traumatic osteoarthritis and wrist instability found with conservative treatment at long-term followup. However, when looking at whether or not an open reduction and internal fixation, without repair of the SLIL, is beneficial to a good radiological score and functional outcome, a study by Forli et al 11 has the longest follow-up with an average of 13 years (range, 10-25). They conclude that there is a tendency for patients to show degenerative changes on X-ray with time and that good reduction, not necessarily the SLIL repair, results in a better radiological score.…”

Treatment of Dorsal Perilunate Dislocations and Fracture–Dislocations Using a Standardized Protocol

“…Through the volar approach, the lunate can be reduced and the volar capsule repaired. The dorsal approach provides access to Table 4 Review of the studies on the combined volar-dorsal approach for perilunate dislocations and fracture-dislocations [1,7,12,13,17,24] Author (year) reduce the scapholunate and lunate-triquetral articulations and fix scaphoid fracture from an antegrade approach [24]. We immobilized the wrist for 10 weeks to assure satisfactory ligament healing [3].…”