Perilunate Dislocations

Abstract

A 37-year-old man injured his right wrist in a motor vehicle collision. In the emergency department he had severe wrist pain and median nerve paresthesia. Wrist radiographs identified a dorsal perilunate dislocation (PLD) with the carpus dislocated dorsally and the lunate tilted volar but still located in the lunate fossa. Post-reduction computed tomography scan confirmed no fractures. THE QUESTIONSWhat is the optimal surgical approach for this patient with a purely ligamentous (i.e., "lesser arc" 1 ) dorsal PLD? What bones should be immobilized and what is the best method of internal fixation? CURRENT OPINIONPLDs are high-energy carpal injuries that result in wrist stiffness and arthrosis even if good carpal alignment is restored. 2e7 PLD merits urgent reduction when there is associated median nerve dysfunction, CME INFORMATION AND DISCLOSURESThe Review Section of JHS will contain at least 2 clinically relevant articles selected by the editor to be offered for CME in each issue. For CME credit, the participant must read the articles in print or online and correctly answer all related questions through an online examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details.The JHS CME Activity fee of $15.00 includes the exam questions/answers only and does not include access to the JHS articles referenced.

Perilunate carpal dislocation. Clinical evaluation of patients operated with reduction and percutaneous fixation without capsular-ligament repair

“…The selected patients were those submitted to closed reduction and percutaneous fixation between the scaphoid and the lunate, scaphoid and capitate, pyramidal and lunate, and between the radius and lunate, with some variations, as will be shown. Mean time for K-wires removal was 10 weeks, as was also demonstrated in other studies, 2 , 9 , 14 but K-wires between the radius and lunate were removed at six weeks.…”

“…The literature indicates a similar interval for removal of the K-wires, ranging from 8 to 12 weeks. 1 , 6 , 9 …”

Surgical Treatment of Chronic Perilunate Dislocation for Prevention of Attritional Flexor Tendon Rupture

“…Siba Haykal MD PhD 1 , Amanda L Pennings HBSc MSc 2 , Karen Y Chung HBSc 1 , Amr W Elmaraghy MD 2,3 P erilunate dislocations and fracture-dislocations comprise a spectrum of ligamentous or bony disruption that result from highenergy trauma to the wrist (1)(2)(3)(4). Diagnosis requires thorough upper-extremity examination, high clinical suspicion, and radiographic examination of the wrist in neutral or radial deviation (2).…”

“…Diagnosis requires thorough upper-extremity examination, high clinical suspicion, and radiographic examination of the wrist in neutral or radial deviation (2). When diagnosed acutely, urgent surgical management is currently the standard of care to achieve and maintain anatomical reduction (2), and minimize the risk of recognized complications including posttraumatic arthrosis, median nerve dysfunction and/or carpal instability (1)(2)(3)(4). Unfortunately, it is frequently misdiagnosed in an acute setting and the treatment of chronic perilunate dislocations is less clear.…”

Patient-Reported Outcomes Following Surgically Managed Perilunate Dislocation

“…5,6 Despite recent studies indicating favorable results with closed reduction, 4 current trends are still for the operative restoration of anatomical alignment and ligamentous repair where necessary. 23,30 Depending on the injury pattern, a singular dorsal or volar approach can be utilized, though combining approaches takes advantage of both exposures. 7,9,10 There is a poor correlation between radiographic indices and functional outcomes, 9,10,28 but with the development of a number of patient-rated outcome scores, it is now possible to elucidate the impact of injuries on heath, quality of life, and wrist disability specifically.…”