Perilunate Injury with Concomitant Short Radiolunate Ligament Disruption: Prevalence and Surgical Outcomes—"An Unusual Perilunate Injury Variant”

Abstract

Background In the classic description of perilunate injuries, the short radiolunate ligament (SRL) remains intact. Objective This study was aimed to determine the occurrence of SRL disruptions with perilunate injuries and review the clinical and radiographic outcomes after surgical management. Patients and Methods A retrospective review was conducted for patients who sustained a perilunate injury and a concomitant disruption of the SRL at a single–level-1 trauma center between January 2013 and January 2017. Patients with the combined injury pattern were compared with those with perilunate injury alone without SRL injury during the study period. Outcome measures included pain scores (visual analogue score), wrist and forearm range of motion, patient's return to their former occupation, and multiple radiographic parameters. Results Twenty-seven patients were treated operatively for a perilunate injury. Eight of these patients (30%) were found to have associated disruption of the SRL. When compared with patients with perilunate injury alone, these patients had a lower rate of return to work (57% [4 of 7] vs. 92% [12 of 13]), a significantly longer mean length of time to return to work (5.9 vs. 3.8 months), and a higher rate of associated upper extremity injury (75% [3 of 8] vs. 16% [3 of 19]. Conclusion Combined SRL disruption and perilunate dislocation or fracture dislocation represent a high-energy variant from the classic description of a perilunate injury. A heightened awareness for this combined injury pattern should be maintained when treating patients with perilunate injuries. Level of Evidence This is a Level III, prognostic study.

Transscaphoid Transcapitate Perilunate Fracture-dislocation with Inferior Arc Injury and Acute Ulnar Nerve Compression: A Case Report

“…We present an unusual case of PLFD with acute ulnar nerve compression; to the best of our knowledge, this has only been previously reported in two case reports with two additional instances reported in cohort studies [ 9 , 10 , 11 , 12 ]. The fracture pattern is also rare, involving an atypical greater arc injury pattern in combination with an inferior arc injury.…”

“…We present a case of PLFD in which the proximal scaphoid fragment dislocated volarly and ulnarly, causing acute compression of the ulnar nerve. Our review of the literature shows only four other reported cases of ulnar neuropathy in the setting of a PLFD and two cases of ulnar neuropathy in the setting of lunate dislocations [ 9 , 10 , 11 , 12 , 13 , 14 ]. Our patient also sustained a lunate facet distal radius fracture with radiocarpal subluxation, resulting in an exceedingly rare injury pattern involving both greater and inferior arc injuries.…”

Development of Complications and Consequences of Perilunar Injuries of the Hand, Depernding on the Chosen Tretment Stratege

“…Это особенно важно, потому что клинические результаты ухудшаются при более длительном периоде наблюдения. В опубликованных исследованиях использовался тыльный [13], ладонный доступ [14] и комбинированный ладонный и тыльный доступ для восстановления всех поврежденных связок и разрыва капсул [15]. Также в некоторых исследованиях был использован артроскопический метод восстановления связочного аппарата [16; 17].…”