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Liechti R, Merky DN, Grobbelaar AO, van de Wall BJM, Vögelin E, Hirsiger S. Outcomes of acute perilunate injuries-a systematic review. Eur J Trauma Emerg Surg 2023; 49:2071-2084. [PMID: 36750472 DOI: 10.1007/s00068-023-02222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date. MATERIAL AND METHODS This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included. RESULTS Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6-7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2-1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1-0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable. CONCLUSIONS Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Rémy Liechti
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
| | - Dominique Nellie Merky
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Adriaan Ockert Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Stefanie Hirsiger
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
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Haug LCP, Adler T, Bignion D, Voegelin E. Radio-luno-triquetral bone-ligament transfer as an additional stabilizer in scapholunate-instability. Arch Orthop Trauma Surg 2021; 141:341-347. [PMID: 33251560 PMCID: PMC7886774 DOI: 10.1007/s00402-020-03690-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Reconstruction of the scapho-lunate (SL) ligament is still challenging. Many different techniques, such as capsulodesis, tendon graft and bone-ligament-bone graft have been described to stabilize reducible SL dissociation. If primary ligament repair alone is not possible, an additional stabilizer is needed to achieve scapho-lunate stability. A new local bone-ligament transfer using half of the radio-luno-triquetral ligament is performed. The direction of traction of the transposed ligament is very similar to the original ligament. Ideal tension can be attained by fixation of the bone block at the dorsal ridge of the scaphoid. The biomechanical stability of this bone-ligament transfer shall be examined biomechanically. MATERIAL AND METHODS Computed tomography imaging was performed using eight cadaveric forearms with a defined position of the wrist. Axial load was accomplished with tension springs attached to the extensor and flexor tendons. Three series ([a] native, [b] divided SL ligament and [c]) after reconstruction with bone-ligament transfer] were reconstructed three-dimensionally to determine the angles between radius, scaphoid and lunate. The radial distal part including a bone fragment of the radio-luno-triquetral ligament was transferred from its insertion at the distal edge of the radius to be attached to the dorsal ridge of the scaphoid. RESULTS SL gap was widened after its transection. Average SL distance was 6.6 ± 1.6 mm. After ligament reconstruction, the gap could be narrowed significantly to 4.2 mm (± 0.7 mm). The movement of the scaphoid and lunate showed significant changes, especially in wrist flexion, fist closure and radial deviation. These deviations could be corrected by the bone ligament transfer. CONCLUSION Reconstruction of a transected SL ligament with a bone-ligament transfer from the radio-luno-triquetral ligament reduces SL dissociation under axial load. The described surgical technique causes low donor-side morbidity and can be considered in addition to improve stability if SL ligament suture alone does not appear sufficient. LEVEL OF EVIDENCE Level II, therapeutic investigating experimental study.
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Affiliation(s)
- Luzian C. P. Haug
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
| | - Tom Adler
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
| | - Dietmar Bignion
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
| | - Esther Voegelin
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
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Kazemian GH, Khak M, Ravarian B, Sarzaeem MM, Okhovatpour MA, Amouzadeh Omrani F. Closed K-wire Fixation for the Treatment of Perilunate Dislocation and Trans-Scaphoid Perilunate Fracture Dislocations without Ligamentous Repair: Short Term Follow-Up. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:633-640. [PMID: 33088866 DOI: 10.22038/abjs.2020.42341.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to evaluate the treatment outcomes of perilunate dislocations (PLDs) and transscaphoid perilunate fracture dislocations (TSPLDs) treated with operative volar approach without ligament repair or reconstruction. Methods A total of seven patients (10 hands) were studied during 2017-2018. We fixed scaphoid fractures thorough a volar approach and 3 k-wires were inserted to stabilize the scaphoid to the adjacent bones. We evaluated patients' range of motion by VAS and grip strength, sensitivity assessment, and radiographs. Mayo and DASH scores were also recorded for wrist evaluation. Results All fractures united well. The mean Mayo wrist score was 81.5. Five patients scored good and excellent results (90-100). Excellent DASH scores (˂20) were observed in 4 patients and there was no poor DASH score (˃50). Conclusion Treatment of PLDs and TSPLDs with k-wire and screw fixation using a volar approach and without any ligament repair or reconstruction results in minimal manipulation and has favorable short-term outcomes.
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Affiliation(s)
- Gholam Hossein Kazemian
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Khak
- Department of Orthopedic Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Behdad Ravarian
- Department of Orthopedic Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Okhovatpour
- Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sgromolo NM, Mullikin IA, Rhee PC. Perilunate Injury with Concomitant Short Radiolunate Ligament Disruption: Prevalence and Surgical Outcomes-"An Unusual Perilunate Injury Variant". J Wrist Surg 2020; 9:312-320. [PMID: 32760610 PMCID: PMC7395845 DOI: 10.1055/s-0040-1710396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
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.
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Affiliation(s)
- Nicole M. Sgromolo
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Ian A. Mullikin
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Peter C. Rhee
- Department of Orthopaedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Rochester, Minnesota
- Clinical Investigation Facility, Travis AFB, California
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Lameijer CM, Niezen CK, El Moumni M, van der Sluis CK. Pain, impaired functioning, poor satisfaction and diminished health status eight years following perilunate (fracture) dislocations. Disabil Rehabil 2018; 42:849-856. [PMID: 30453787 DOI: 10.1080/09638288.2018.1512165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Perilunate (fracture) dislocations are rare injuries and diminished functional outcomes are reported. However, Patient Reported Outcomes (PROs) following these injuries are rarely described. The aim of this study was to investigate the long-term impact of perilunate (fracture) dislocations using a range of measures, including pain, function, and quality of life.Materials and Methods: This cross-sectional study was conducted from January 2016 until March 2016. Eleven patients who had suffered from perilunate (fracture) dislocations between August 1996 and January 2014 were matched on age and gender with 22 healthy controls. Functional outcome included range of motion and grip strength measurements. The Patient Reported Outcomes included: Patient Reported Wrist Evaluation, Disability of Arm, Shoulder and Hand questionnaire, Michigan Hand Questionnaire and the Short Form-36.Results: The 11 patients that were included (9 males) had a median age at injury of 38 years (IQR 33; 54) and median follow up of 97 months (IQR 84-193). Flexion/extension (mean difference -60°, 95% CI -76, -43, p < 0.001) and ulnar/radial deviation (mean difference -28°, 95% CI -38, -18, p < 0.001) were significantly diminished in patients following perilunate (fracture) dislocations. Grip strength was not affected. The patients experienced significantly more pain as assessed on all pain subscales. Physical functioning was significantly worse in the group with perilunate (fracture) dislocations as assessed on all function subscales, except the PRWE function score and the subscale physical functioning of the Short Form-36. Satisfaction as measured with the Michigan Hand Questionnaire satisfaction subscale (mean difference -36, 95% CI -57, -16, p = 0.002) was also reported poorer. No difference was found regarding work participation.Conclusions: A perilunate (fracture) dislocation has a significant impact on everyday life, as patients experience diminished range of motion, pain, diminished physical functioning, diminished satisfaction and report lower general health status than healthy controls. However, no consequences for work participation were found in this study. Level of evidence 3.Implications for rehabilitationFlexion/extension and ulnar/radial deviation remains limited following perilunate (fracture) dislocations.Grip strength is not diminished in patients with perilunate (fracture) dislocations.Pain, restrictions in physical functioning, diminished satisfaction and lower general health status are likely to be present following perilunate (fracture) dislocations.If conservative treatment including pain medication and rehabilitation strategies do not relief pain following perilunate (fracture) dislocations, surgical treatment options such as wrist denervation or arthrodesis should be considered.
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Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Caren K Niezen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Peri-lunate dislocation and fracture-dislocation of the wrist: Retrospective evaluation of 65 cases. Orthop Traumatol Surg Res 2016; 102:351-5. [PMID: 26897257 DOI: 10.1016/j.otsr.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 12/23/2015] [Accepted: 01/01/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Peri-lunate wrist dislocations and fracture-dislocations are related to high-energy trauma. Prognosis is often compromised because of the complexity of the lesions. The purpose of this study was to assess outcomes of acute peri-lunate injuries and correlate them with the type of lesion and management. MATERIEL AND METHODS A monocenter retrospective study has been conducted. Sixty-five patients (65 wrists) were reviewed. According to Herzberg's classification, there were 18 isolated peri-lunate dislocations and 47 peri-lunate fracture-dislocations - 27 with a scaphoid fracture and 20 with an intact scaphoid. The displacement was dorsal in 62 cases. All patients were treated surgically. RESULTS At an average follow-up of 8 years (2-16) the average Cooney score was 66 points, quick-DASH score 21 points, and PRWE score 28 points. Pain score was 1.3 out of 10 points at rest and 4.3 out of 10 with effort. The flexion-extension arc was 96° with an average strength of 38kg (70±23% of opposite side). Radiographic analysis has shown decrease in carpal height, increase in ulnar translation, and DISI. Sign of wrist arthritis was found in 58.5% of the cases. The rate of osteonecrosis was 7.7%. Regional sympathetic painful syndrome was observed in 12%. In 26% of the cases a secondary surgery was needed. No influence has been found with the final results between fracture-dislocation and isolated dislocation, and delay of treatment. Osteochondral lesions observed at surgery (P=0.035), osteonecrosis at follow-up (P=0.017), and modification of the scapho-lunate angle (P=0.029) were correlated with the occurrence of osteoarthritis. DISCUSSION Peri-lunate dislocation and fracture-dislocation represent severe wrist trauma with often numerous sequelae with follow-up: pain, stiffness, loss of strength, carpal instability and arthritis. Early diagnosis and anatomic reduction are prerequisite to a satisfactory functional result. Capsulo-ligamentous lesions must be repaired and fractures must be fixed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Başar H, Başar B, Erol B, Tetik C. Isolated volar surgical approach for the treatment of perilunate and lunate dislocations. Indian J Orthop 2014; 48:301-5. [PMID: 24932038 PMCID: PMC4052031 DOI: 10.4103/0019-5413.132523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries. MATERIALS AND METHODS 9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores. RESULTS The physical rehabilitation was started at 6(th) week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°. CONCLUSION The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.
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Affiliation(s)
- Hakan Başar
- Department of Orthopedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey,Address for correspondence: Dr. Hakan Başar, Eski Kazımpaşa cad. yolu Arabacı alanı mah. Akkent villaları NO: 156/25 Serdivan/Sakarya, Turkey. E-mail:
| | - Betül Başar
- Department of Physical Medicine and Rehabilitation, Akyazı State Hospital, Sakarya, Turkey
| | - Bülent Erol
- Department of Orthopaedic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Cihangir Tetik
- Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, Istanbul, Turkey
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Capo JT, Corti SJ, Shamian B, Nourbakhsh A, Tan V, Kaushal N, Debkowska M. Treatment of dorsal perilunate dislocations and fracture-dislocations using a standardized protocol. Hand (N Y) 2012; 7:380-7. [PMID: 24294157 PMCID: PMC3508016 DOI: 10.1007/s11552-012-9452-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aims of this study were to evaluate the associated injuries occurring with acute perilunate instability and to assess the clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with a combined dorsal and volar approach. METHODS A total of 45 patients (46 wrist injuries) with perilunate dislocations and fracture-dislocations were prospectively evaluated. The size of the mid-carpal ligament tear, the location of the scapholunate ligament tear, and the presence of osteochondral fragments and of the dorsal radiocarpal ligament avulsions were recorded at injury. Final clinical and radiographic outcomes were evaluated in 25 cases (25 wrists) with a minimum of 6 months of follow-up. RESULTS Intraoperative examination of the 46 cases with operative treatment showed the volar carpal ligament tear to be present 100 % of the time and to be an average length of 3.4 cm. Complete avulsion of the dorsal extrinsic radiocarpal ligaments was found in 65.2 % of cases. The scapholunate ligament was torn in 35 cases. Osteochondral fragments were found either volarly or dorsally in 74 % of the cases. The average flexion-extension arc was 82°, forearm rotation was 155°, and grip strength averaged 59 % of the uninjured hand. The average final scapholunate angle was 55° and the scapholunate gap was 2.2 mm. CONCLUSION Treatment of perilunate fracture-dislocations with a combined volar and dorsal approach results in reasonable and functional clinical results. The incidence of associated injuries with these carpal dislocations is high. Although the perilunate fracture-dislocations have a slightly better radiologic alignment than the dislocation group, the clinical outcome is similar.
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Affiliation(s)
- John T. Capo
- Department of Orthopaedics, NYU Medical Center–Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 USA
| | - Sandro J. Corti
- Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200 Newark, NJ USA
| | - Ben Shamian
- Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200 Newark, NJ USA
| | - Ali Nourbakhsh
- Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200 Newark, NJ USA
| | - Virak Tan
- Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200 Newark, NJ USA
| | - Neil Kaushal
- Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200 Newark, NJ USA
| | - Monika Debkowska
- Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200 Newark, NJ USA
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[Clinical findings and treatment of perilunar dislocations and dislocation fractures]. Unfallchirurg 2012; 115:576-81. [PMID: 22806222 DOI: 10.1007/s00113-012-2177-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Perilunate dislocations, dislocation fractures and lunate dislocations are rare injuries predominantly resulting from hyperextension of the wrist during high-energy trauma. Early recognition and treatment of these injuries usually results in good functional outcome despite degenerative changes on radiographs. Immediate reduction and adequate restoration of normal alignment are the key to successful healing. Surgical intervention with open reduction and ligament repair aims at stable reconstruction of the carpus. It requires broad surgical experience and a profound knowledge of normal anatomy.
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Chou YC, Hsu YH, Cheng CY, Wu CC. Percutaneous screw and axial Kirschner wire fixation for acute transscaphoid perilunate fracture dislocation. J Hand Surg Am 2012; 37:715-20. [PMID: 22386559 DOI: 10.1016/j.jhsa.2012.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 01/13/2012] [Accepted: 01/13/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE In this retrospective, nonrandomized study, we evaluated the clinical outcomes of percutaneous screw and K-wire fixation in the treatment of acute transscaphoid perilunate fracture dislocation. METHODS Between 2004 and 2009, we studied 24 patients treated by fixation with a 2.0-mm (0.078-in) axial K-wire across the capitolunate joint and a percutaneous screw (3.0-mm AO cannulated screws were used in 13 patients, and Herbert-Whipple screws were used in 11 patients) within 7 days of the injury. We performed a comparative radiographic assessment of the scapholunate angle, radiolunate angle, capitolunate angle, revised carpal height ratio, and gap between the scapholunate joint between the injured wrist and the contralateral, healthy wrist. Clinical outcomes were evaluated on the basis of range of motion, pain, functional status, and Mayo scores. RESULTS Twenty-three patients (96%) achieved scaphoid union at a mean union time of 18 weeks (range, 14-28 wk). Radiographic assessments revealed no statistically significant difference between the injured wrist and the contralateral, healthy wrist. However, significant differences were noted in the mean range of motion during flexion and forearm supination between the injured wrist and contralateral healthy wrist. The mean wrist function results were encouraging, and the average Mayo score was 83. CONCLUSIONS A percutaneous procedure involving screw fixation for the scaphoid fracture and an axial K-wire fixation for intercarpal dislocation is a successful treatment for acute transscaphoid perilunate fracture dislocation. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Ying-Chao Chou
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Luxations et fractures-luxations périlunaires du carpe, étude rétrospective d’une série de 17 cas. ACTA ACUST UNITED AC 2012; 31:62-70. [DOI: 10.1016/j.main.2012.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/30/2011] [Accepted: 01/15/2012] [Indexed: 11/18/2022]
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Prommersberger KJ. [Editorial: wrist joint encroachment]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 21:359-60. [PMID: 20058115 DOI: 10.1007/s00064-009-1901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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