Treatment of acute perilunate dislocations: ORIF versus proximal row carpectomy

Oliveira

Revista Iberoamericana de Cirugía de la Mano

et al. 2021

Perilunate injuries are complex and rare lesions with circumferential carpal bones, ligamentous and cartilage involvement. Despite optimal surgical treatment, poor prognosis is expected and usually gets worse over time. Our aim was to address clinical and radiological outcomes after 2 years of follow-up. Seven wrists were revised with average age of 35.59 ± 14.01 (range 21–56) years old and mean follow-up of 44.10 ± 14.24 (range 25.60–68.63) months. At the latest follow-up, mean postoperative VAS score for pain was 2.71 ± 3.40 and DASH score was 10.48 ± 10.54. Patients returned to work in 5.00 ± 3.15 months. Strength and Range of Motion (ROM) parameters were ∼80% of the contralateral side, with exception for extension (61%) and radial deviation (73%). After 2 years of follow-up, radiographic arthrosis was observed in 29% of the cases. One of these patients was symptomatic and was proposed for arthrodesis. Mean carpal height was 1.51 ± 0.81 and scapholunate angle was 41.58 ± 22.82°. A correlation was observed between arthritis found at final follow-up and grip (r = −0.8660; p < 0.001) and pinch strength (r = −0.8885; p < 0.001). In conclusion, despite characteristic guarded prognosis, efforts to perform a prompt and adequate treatment are helpful. Clinical and radiological outcomes may not be related. Thus, it is of main importance to understand patients' perception of their sequelae.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perilunate Lesions – Clinical and Radiological Results with a Minimum of 2 Years of Follow-up

Oliveira

Revista Iberoamericana de Cirugía de la Mano

et al. 2021

Case Reports in Orthopedics

“…Due to the number of less than optimal results with ORIF, many authors have opted for salvage procedures as the primary operation, particularly in the setting of severe carpal trauma [ 12 ]. In a retrospective cohort analysis, Muller et al [ 1 ] compared ORIF against proximal row carpectomy (PRC) for the treatment of acute perilunate dislocations. In their study, 13 patients were treated by ORIF while 8 patients were treated by PRC with an average follow up of 35 months.…”

Section: Discussionmentioning

confidence: 99%

“…Perilunate injuries are relatively rare, accounting for only 7% of pathologies to the carpus. However, a staggering number of these injuries are not diagnosed, with up to 25% of perilunate dislocations being missed on initial presentation [ 1 – 3 ]. The importance of identifying these injuries is highlighted by the significant complications produced by missed or improperly treated injuries including median nerve injury, chronic carpal instability, avascular necrosis of the mal-reduced lunate, complex regional pain syndrome, unreliable return of function, and posttraumatic arthrosis requiring a secondary procedure [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Case Report of an Acute Complex Perilunate Fracture Dislocation Treated with a Three-Corner Fusion

Matthewson

Larrivée

Clark

2018

Perilunate fracture dislocations are a rare but devastating injury, which is often missed on initial presentation leading to significant delays in treatment. With the delay in treatment and a high energy mechanism of injury, patients are at increased risk of developing complex regional pain syndrome following trauma. In this report, we review the case of a 57-year-old left-hand dominant female who presented to a clinic with a five-and-a-half-week-old transtriquetral, perilunate fracture dislocation with comminution of the scaphoid facet. Due to the increased likelihood of a secondary procedure and low probability of a satisfactory outcome with open reduction internal fixation secondary to the loss of the scaphoid articulation, a salvage procedure was deemed her best option. To our knowledge, this is the first case reported in the literature in which a scaphoidectomy, triquetromy, and midcarpal fusion (three-corner fusion) was performed in the acute setting for a perilunate fracture dislocation.

“…Many authors presumed that ligament repair was absolutely necessary to maintain the reduction as well as the restoration of carpal alignment to optimize the outcome. Despite a number of successful cases that opted for closed reduction, percutaneous fixation or open reduction are ultimately required to maintain the reduction (13,14).…”

Section: Discussionmentioning

confidence: 99%

Transradial Styloid Perilunate Dislocation: A Rare Case

Rahimi¹,

Parsa²,

Hotkani³

et al. 2017

Trauma Mon

Although perilunate fracture-dislocation usually extremely alters the inter-carpal relationships, it is frequently misinterpreted during initial evaluations. In the current study, two 30-year-old males with a very rare transradial styloid perilunate fracture-dislocation were studied; they were treated by closed reduction and percutaneous K-wire fixation. They regained the range of motion (ROM) of their wrist and furthermore, the mid-term outcome turned out to be satisfactory.