26
|
Brown KV, Tsekes D, Gorgoni CG, Di Mascio L. The treatment of perilunate ligament injuries in multiply injured patients. Eur J Trauma Emerg Surg 2017; 45:73-81. [PMID: 29018873 DOI: 10.1007/s00068-017-0856-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Perilunate injuries are rare, severe injuries of the carpus. They can present as isolated injuries or in the poly-traumatised patient. This is the first documented series of these injuries treated in a Major Trauma Centre. The aims were to assess the management, treatment algorithm and outcomes, of perilunate injuries in our department, review whether concomitant polytrauma affected those outcomes and identify if delay to definitive treatment had a significant effect on overall outcome. METHODS Perilunate injuries admitted to the Royal London Hospital between Oct 2011 and March 2016 were identified. All definitive surgical procedures were performed by the senior author; hand therapists supervised patient rehabilitation. Outcomes were assessed by Mayo Wrist and QuickDASH scores. RESULTS We identified 23 perilunate injuries (22 patients). There was an associated nerve injury in 10 cases with other system injuries present in 12 cases. At final review, the mean carpal height ratio was 0.56, Mayo Wrist score was 81 and QuickDASH score was 16.4. There were no differences when comparing the outcomes of patients who had early against those with more delayed definite treatment or when comparing patients with isolated wrist injuries against polytrauma patients. CONCLUSION Satisfactory outcomes can be achieved, even in the presence of other injuries, if initial treatment is prompt and follows a clear management protocol. Prompt early reduction and neurological decompression followed by subsequent accurate definitive fixation leads to good outcomes. A delay of definitive fixation of up to 18 days does not appear to have a deleterious effect on outcome.
Collapse
|
27
|
Khan SA, Van Velze M, Pearse A. A rare case of an acute lunate dislocation in a child. BMJ Case Rep 2017; 2017:bcr-2017-222180. [PMID: 28978611 PMCID: PMC5652598 DOI: 10.1136/bcr-2017-222180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/04/2022] Open
Abstract
Acute lunate dislocations are unusual and devastating injuries to the wrist. They are very rare in adult wrist injuries but extremely rare in children. Only six cases of perilunate dislocations in children have been reported in the literature, and in addition to this, only a single case of a lunate dislocation in a child has been reported.Here, we report a case of a 10-year-old boy who presented with an acute lunate dislocation of the wrist, following trauma, a second of its kind.
Collapse
|
28
|
Lee JM, Kim JK, Lee KB. Extreme proximal migration of dislocated lunate over carpal ligament - A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:177-180. [PMID: 28017515 PMCID: PMC6197394 DOI: 10.1016/j.aott.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/25/2015] [Accepted: 02/06/2015] [Indexed: 12/03/2022]
Abstract
Dislocation of the lunate and proximal pole of the scaphoid with displacement of the fragments proximal to the radiocarpal joint, characterized as a total dislocation, is very rare, with only six cases reported. Dislocated lunate are generally located around the radiocarpal joint or within carpal ligament. However, there have been no reports of dislocated lunate over the carpal ligament. We present a patient with volar dislocation of the lunate that featured extreme migration to approximately 6 cm proximal to flexor digitorum superficialis through the transcarpal ligament.
Collapse
|
29
|
Yao YC, Wang JP, Huang TF, Chang MC, Huang YC. Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrist. J Chin Med Assoc 2017; 80:117-120. [PMID: 27839956 DOI: 10.1016/j.jcma.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Four-corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure. METHODS We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow-up period was 44.5 months (range, 22-68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion-extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded. RESULTS Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion-extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies. CONCLUSION Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain-free wrist. Moreover, these results were maintained at follow-up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four-corner fusion for advanced degenerative osteoarthritis of wrists.
Collapse
|
30
|
Abstract
Thirty-nine patients were retrospectively reviewed after a wrist arthrodesis using a Synthes wrist fusion plate and iliac crest bone graft. Information was obtained from review of patient files, a questionnaire to assess pain, function and work status, and clinical assessment of grip strength, forearm rotation and fingers motion. All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. Thirty-seven patients were satisfied with the procedure, noting a reduction in wrist pain after fusion, but all reported some limitation of function. The wrist fusion plate was removed in six patients and a further four patients experienced minor symptoms over the dorsal aspect of the middle finger metacarpal.
Collapse
|
31
|
Kasture S, Sakamuri R. Translunate, Transradial, Transtriquetral, Transtrapezoid Perilunate Dislocation With Multiple Metacarpal Neck Fractures. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2017; 46:E435-E438. [PMID: 29309459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a rare case of translunate, transradial, transtriquetral, transtrapezoid perilunate dislocation with multiple metacarpal neck fractures in a young adult. The injury was treated with open reduction and internal fixation. Although the injury was severe, the patient had a satisfactory functional result.
Collapse
|
32
|
Mahjoub S, Dunet B, Thoreux P, Masquelet AC. Transverse translunate fracture-dislocation: A rare injury. HAND SURGERY & REHABILITATION 2016; 35:220-224. [PMID: 27740466 DOI: 10.1016/j.hansur.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/13/2016] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
Perilunate fracture-dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture-dislocation. The patient returned to normal activities after 6 months.
Collapse
|
33
|
El Assil O, Tatar M, Uzel AP. Floating forearm with pure dislocations. HAND SURGERY & REHABILITATION 2016; 35:225-228. [PMID: 27740467 DOI: 10.1016/j.hansur.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/03/2016] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
|
34
|
Liu B, Chen SL, Zhu J, Wang ZX, Yang C, Shen J, Tian GL. [Arthroscopic management of lesser arc perilunate injuries]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2016; 48:234-236. [PMID: 27080273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the outcomes of lesser arc perilunate injuries (Perilunate dislocations) treated with arthroscopically assisted mini-invasive reduction and fixation. METHODS Between 2012 and 2014, 5 patients who had a perilunate dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 17.8 months (range, 10 to 32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo wrist score; Quick disabilities of the arm, shoulder and hand questionnaire; and patient-rated wrist evaluation score. Radiographic evaluations included carpal alignments and any development of arthritis. RESULTS The range of flexion-extension motion of injured wrist averaged 84% of the values for contralateral wrist. The grip strength of the injured wrist averaged 90% of the values for the contralateral wrists. The mean Quick Disabilities of the arm, shoulder and hand score was 1, and the mean Patient-Rated Wrist Evaluation score was 5. According to the Mayo wrist scores, the overall functional outcomes were rated as excellent in all the patients. Reduction obtained during the operation was maintained within normal ranges in all the patients. Arthritis had not developed in any patient at the end of the follow-up. CONCLUSION Arthroscopic mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate dislocations according to our early results.
Collapse
|
35
|
Marcuzzi A, Leigheb M. Transcapho perilunate dislocation with palmar extrusion of the scaphoid proximal pole. ACTA BIO-MEDICA : ATENEI PARMENSIS 2016; 87 Suppl 1:127-130. [PMID: 27104332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
Perilunate fracture-dislocations usually combine ligament ruptures, bone avulsions, and fractures in different patterns. Rarely a displaced fracture of the scaphoid can coexist with a scapho-lunate dissociation and can result in enucleation of the proximal pole. We report about a case of trans-scaphoid perilunate dislocation with palmar extrusion/enucleation of the scaphoid proximal pole, treated with scaphoid fracture open reduction and internal fixation with screw, scapho-lunate ligament repair with an anchor and vascularization of the scaphoid proximal pole with the 2nd intermetacarpal artery. At 52 months follow up we had good clinical and radiographic results. In conclusion, scientific literature including our experience about this rare complex lesion of the wrist is too weak to support an effective strategy of management but we think that the careful analysis of the single problems can be the key to solve the complexity. Goal of the treatment should be complete revascularization and healing of the scaphoid, avoiding non union and avascular necrosis; simultaneously a proper ligament reconstruction is fundamental to re-establish carpal stability. Prevention of carpal collapse for a SNAC o SLAC situation is essential to reach a good level of Quality of Life and satisfaction of the patient.
Collapse
|
36
|
van de Grift TC, Ritt MJPF. Management of lunotriquetral instability: a review of the literature. J Hand Surg Eur Vol 2016; 41:72-85. [PMID: 26188693 DOI: 10.1177/1753193415595167] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Lunotriquetral ligament injury is a relatively common cause of ulnar-sided wrist pain. Injury ranges from partial stable ligament tears to extensive perilunate instability. Clinical decision-making largely depends on the chronicity, instability and cause of the ligament injury. Conservative treatment is generally regarded as first choice of treatment of mild lunotriquetral instability; however, outcome studies on conservative treatment are lacking. Temporary arthroscopic pinning and/or debridement are minimally invasive procedures of preference. In the case of more dissociative injury, surgical interventions may be performed. The literature suggests that soft tissue reconstruction is an effective procedure in this group. Arthrodesis of the lunotriquetral joint is associated with high rates of non-union (up to 57%) and the indications for surgery should therefore be very clear. Methodological issues make it hard to draw firm conclusions from the data. Studies on the effectiveness of conservative management and prospective comparative studies will further improve clinical decision-making in lunotriquetral instability. LEVEL OF EVIDENCE N/A.
Collapse
|
37
|
Kara A, Celik H, Seker A, Kilinc E, Camur S, Uzun M. Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors. Int J Surg 2015; 24:57-63. [PMID: 26542987 DOI: 10.1016/j.ijsu.2015.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/23/2015] [Accepted: 10/24/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Perilunate injuries are rare entities which can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). The purpose of treatment is anatomic reduction and stable fixation. We aimed to present the radiologic and functional results of surgically treated dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis. METHODS Between 2007 and 2013, 17 patients were operated for perilunate fracture-dislocations. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated by comparing with contralateral side on plain x-ray images in terms of radiologic evaluation. RESULTS Mean follow-up was 37,8 (range, 16-84) months. The average age at surgery was 35.1 (range, 18-51) years. Fifteen patients were male and two were female. Functional results were excellent in four (23.5%), good in two (11.8%), satisfactory in five (29.4%) and poor in six (35.3%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 14 wrists (82.4%). Scapholunate dissociation more than 2 mm was detected in three wrists. In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results. CONCLUSION Despite anatomic reduction, ligamentous and chondral injuries that occured at the time of trauma may cause persistant wrist pain in patients who suffer perilunate fracture dislocation. Mechanism of injury, presence of soft tissue defects and the time between injury and treatment can affect clinical and radiologic results.
Collapse
|
38
|
Abstract
Although the true incidence of scapholunate interosseous ligament (SLIL) injury is unknown, a study found that 35% of cadaveric wrists had some degree of scapholunate tear. Of those wrists with SLIL injury, 29% had evidence of arthrosis. Early recognition and treatment of these injuries can delay or prevent the onset of arthritis. This article details treatment options for SLIL injury across the spectrum of pathology with a particular emphasis on chronic scapholunate repair and reconstruction. New techniques and outcomes data also are presented.
Collapse
|
39
|
Langner I, Fischer S, Eisenschenk A, Langner S. Cine MRI: a new approach to the diagnosis of scapholunate dissociation. Skeletal Radiol 2015; 44:1103-10. [PMID: 25761726 DOI: 10.1007/s00256-015-2126-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the feasibility of cine MRI for the detection of scapholunate dissociation (SLD) and to compare the sensitivity and specificity of cine MRI with those of cineradiography and arthroscopy. MATERIALS AND METHODS To evaluate feasibility, healthy subjects underwent cine MRI of the wrist. To evaluate sensitivity and specificity, patients with clinically suspected scapholunate ligament (SLL) injury after trauma to the wrist were prospectively included and underwent radiographic examination, cineradiography, and cine MRI. In 25 out of 38 patients, subsequent arthroscopy was performed. Results of cineradiography and cine MRI correlated with those of arthroscopy. RESULTS Cine MRI was of diagnostic quality in all healthy subjects and patients with good interrater agreement. There was excellent correlation between cineradiography and cine MRI. Scapholunate distance differed significantly between healthy subjects and patients with scapholunate dissociation (p < 0.001), but not between imaging modalities in the patient group. Cine MRI had 85% sensitivity and 90% specificity for the detection of SLD. CONCLUSION Cine MRI of the wrist is a fast and reliable technique for the detection of SLD with diagnostic accuracy comparable to cineradiography. It can be easily implemented as a routine clinical MRI examination, facilitating diagnostic workup of patients with suspected SLD while avoiding radiation exposure.
Collapse
|
40
|
Abstract
Perilunate dislocations and fracture dislocations are the result of an axial load with hyperextension and ulnar deviation of the wrist, combined with intercarpal supination. Prompt treatment injuries is essential. There is a high rate of missed or incorrect diagnosis. In the past, closed management was recommended. These methods proved to be ineffective. Current research and data show better results with anatomic restoration of carpal alignment and direct ligament repair. A combined dorsal and volar approach is preferred. This article reviews the current literature and discusses the surgical techniques to restore carpal alignment and repair the scapholunate interosseous ligament.
Collapse
|
41
|
Wilke B, Kakar S. Delayed Avascular Necrosis and Fragmentation of the Lunate Following Perilunate Dislocation. Orthopedics 2015; 38:e539-42. [PMID: 26091230 DOI: 10.3928/01477447-20150603-92] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/24/2014] [Indexed: 02/03/2023]
Abstract
Perilunate and perilunate fracture dislocations are high-energy injuries with the wrist loaded in extension, ulnar deviation, and intercarpal supination. The force vector travels from a radial to a ulnar direction and can result in complex carpal instability. The diagnosis is often delayed, which can result in suboptimal outcomes. Nonoperative management can produce inferior results, with patients experiencing pain and weakness. Therefore, early treatment with open reduction and internal fixation is recommended to assess the osteochondral and ligamentous disruption and to achieve anatomic reduction of the carpus. Despite this, these patients can develop radiographic degenerative joint disease, which can be seen in up to 90% of cases. This can be due to difficulty in holding and maintaining carpal reduction. Increased radiodensity of the lunate following these injuries has been observed but is believed to be a transient phenomenon without risk of progression to avascular necrosis. This may be due to the blood supply of the lunate, which has varied patterns of intraosseous and extraosseous vascularity. The authors report a patient who developed avascular necrosis and delayed lunate fragmentation following a May-field Type IV perilunate dislocation. This finding highlights the importance of long-term follow-up with these patients.
Collapse
|
42
|
Vitale MA, Seetharaman M, Ruchelsman DE. Perilunate dislocations. J Hand Surg Am 2015; 40:358-62; quiz 362. [PMID: 25459380 DOI: 10.1016/j.jhsa.2014.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 02/02/2023]
|
43
|
Lüninghake FJ. [Checklist: wrist fractures]. MMW Fortschr Med 2015; 157:53. [PMID: 25743303 DOI: 10.1007/s15006-015-2589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Kitay A, Mudgal C. Volar carpal subluxation following lunate facet fracture. J Hand Surg Am 2014; 39:2335-41. [PMID: 24908555 DOI: 10.1016/j.jhsa.2014.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 03/26/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
|
45
|
Rohman L, Hebron A. Perilunate fracture dislocation. J Emerg Med 2014; 47:e90-e93. [PMID: 24746911 DOI: 10.1016/j.jemermed.2013.08.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 06/03/2023]
|
46
|
Zhou Y, Liu S, Yu L, Liao Q, Huang T, Zhang C. [Kirschner wire fixation in three joints combined with bone anchor repair for treatment of acute perilunate injury ]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2014; 28:1086-1090. [PMID: 25509771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint combined with bone anchor repair for the treatment of acute perilunate injury. METHODS Between January 2007 and January 2012, 35 cases of acute perilunate injury were treated. There were 30 males and 5 females with an average age of 45.5 years (range, 32-56 years). Fractures were caused by falling from height in 18 cases, by traffic accident in 11 cases, and by fall injury in 4 cases. The time from injury to operation was 2-6 days (mean, 3.4 days). There were 23 cases of trans-scaphoid perilunate dislocation, 10 cases of perilunate dislocation, and 2 cases of trans-triangular perilunate dislocation. Associated injuries included median nerve injury in 6 cases, radius styloid fracture in 8 cases, ulnar styloid fracture in 2 cases, and distal tibial fracture in 1 case. All the patients were treated by open reduction, Herbert screw fixation of scaphoid fractures, and Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint, and the intercarpal ligaments were repaired by Mitek bone anchor. RESULTS Superficial wound infection occurred in 2 cases, and primary healing of incision obtained in others. Thirty-five patients were followed up 12-35 months (mean, 18 months). X-ray films showed fracture union in 21 cases of scaphoid fractures, and bone nonunion in 2 cases of scaphoid fractures. During the follow-up period, there was no avascular necrosis ofscaphoid or lunate. At last follow-up, the scapholunate angle, radiolunate angle, and wrist range of motion (ROM) in extension had no significant difference between affected and unaffected sides (P > 0.05). The wrist ROM in flexion and grip strength of affected side were not up to the levels of unaffected side (P < 0.05). According to the modified Mayo wrist scoring system, the score was 79.9 ± 10.7, which were excellent in 8 cases, good in 17 cases, fair in 7 cases, and poor in 3 cases, and the excellent and good rate was 71.4%. The disability of arm-shoulder-hand (DASH) questionnaires score was 21 ± 10. Traumatic osteoarthritis was observed in 2 cases. CONCLUSION Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint combined with bone anchor repair for the treatment of acute perilunate injury can get early stability of the carpal joint, favorable intercarpal ligament repair, and good recovery of wrist joint function.
Collapse
|
47
|
Suzuki D, Ono H, Furuta K, Katayama T, Akahane M, Omokawa S, Tanaka Y. Comparison of scapholunate distance measurements on plain radiography and computed tomography for the diagnosis of scapholunate instability associated with distal radius fracture. J Orthop Sci 2014; 19:465-70. [PMID: 24473829 DOI: 10.1007/s00776-014-0533-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate radiographic criteria for scapholunate instability (SLI) in the setting of distal radius fracture (DRF) confirmed by arthroscopy. METHODS Eighty-eight wrists with DRF treated by open reduction and internal fixation and assessed for SLI arthroscopically were evaluated. The scapholunate distance (SLD) was measured by preoperative posteroanterior wrist radiography and computed tomography (CT). SLD on radiographs was measured as the distance between the scaphoid cortex and the lunate cortex at the center of the scapholunate joint. SLDs were measured at the volar end (A1), center (A2), and dorsal end (A3) of the scapholunate joint on the central CT axial slice; and at the proximal end (C1), center (C2), and distal end (C3) of the scapholunate joint on the central CT coronal slice. Wrists were divided into three groups by arthroscopic assessments: stable (normal, Geissler grade 1 or 2), G3 (Geissler grade 3), and G4 (Geissler grade 4). SLD measurements on radiographs and CTs (A1-C3) were compared among the three groups. Receiver-operating characteristic (ROC) curve analyses were performed to evaluate the abilities of SLD measurements on radiographs and CTs to identify SLI in wrists with DRF. Interobserver and intraobserver reliabilities of SLD measurements on radiographs and CTs were analyzed by intraclass correlation coefficients (ICCs). RESULTS SLDs of C3 differed significantly among the G3 and G4 groups, and among the stable and G4 groups. The area under the curve on ROC curve analysis was 0.855 for the SLD of C3, which was larger than that for SLD on radiographs. For C3, the intraobserver ICC was 0.832 and interobserver ICC was 0.73. CONCLUSIONS SLD at the distal end of the scapholunate joint on the central coronal CT slice was the most appropriate measurement for discrimination of Geissler grade 4 SLI in wrists with DRF. LEVEL OF EVIDENCE Level 2.
Collapse
|
48
|
Lo BM, Kerns B. Bilateral perilunate dislocation after a fall. J Emerg Med 2014; 46:223-224. [PMID: 24113485 DOI: 10.1016/j.jemermed.2013.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
|
49
|
Asano T, Hidaka Y. Two cases of proximal pole scaphoid fracture accompanied by lunate fracture. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2014; 19:231-235. [PMID: 24875509 DOI: 10.1142/s0218810414720162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We experienced two cases of simultaneous fracture of the scaphoid and the lunate. In two cases, both scaphoid and lunate fractures existed on the same plane, which may help us to understand the mechanism of proximal fracture of the scaphoid.
Collapse
|
50
|
Mawdsley MJ, Jalul M, Humphreys AR. Distal scaphoid fracture and scapholunate ligament injury in a child. J Hand Surg Eur Vol 2013; 38:574-5. [PMID: 23442340 DOI: 10.1177/1753193413479722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|