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Abola MV, Gerber BA, Rocks MC, Chen JS, Hacquebord JH, Azad A. A Comparison of Outcomes in Acute Perilunate Injuries: Systematic Review and Meta-Analysis of Treatment Approaches. Hand (N Y) 2024:15589447241231291. [PMID: 38415721 DOI: 10.1177/15589447241231291] [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] [Indexed: 02/29/2024]
Abstract
BACKGROUND Perilunate dislocations (PLD) and fracture-dislocations (PLFD) comprise a spectrum of high-energy wrist injuries. The purpose of this review was to review operative strategies for perilunate injuries based on approach and compare outcomes. METHODS A systematic review of literature on PLD and fracture-dislocations was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed and EMBASE databases were queried for literature. Inclusion criteria included English studies reporting clinical or functional outcomes of acute PLD and PLFD. RESULTS Twenty-nine full-text articles (604 PLD and PLFD injuries) were included. The most common method of PLD and PLFD fixation is through an open approach with combined volar and dorsal exposure. There were no differences between approaches with regard to total arc range of motion, grip strength, Mayo Wrist Score, or mean scapholunate angle. Similarly, there was no difference between approaches and postoperative radiographic arthritis or complications. Most patients were able to return to their prior level of function and work. The incidence of postoperative complications ranged from 0% to 22.5%. CONCLUSION Current evidence shows no difference in postoperative total wrist arc range of motion, grip strength (as compared to contralateral), or Mayo Wrist Score with regard to surgical approach. The most common method of PLD and PLFD fixation in the literature is through an open approach with combined volar and dorsal exposure. There is a large difference in reported rates of radiographic arthritis, although this finding does not appear to correlate with postoperative pain or disability. LEVEL OF EVIDENCE I, Systematic Review.
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Affiliation(s)
- Matthew V Abola
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Brett A Gerber
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Madeline C Rocks
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jeffrey S Chen
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jacques H Hacquebord
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
- Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Ali Azad
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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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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Cievet M, Buffard M, Kumble A, Ramos-Pascual S, Locquet V, Burnier M. Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00114-7. [PMID: 37364729 DOI: 10.1016/j.hansur.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
The purpose of the study was to compare outcomes of fully-arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) to treat acute traumatic lunate fractures. A literature search was conducted using Medline and Embase. Demographic data and outcomes were extracted for included studies. The search identified 2,146 references: 17 articles were included, reporting on 20 cases (4 ARIF and 16 ORIF). No differences between ARIF and ORIF were found in rate of union (100% vs 93%, P = 1.000), grip strength (mean difference, 8%; 95%CI, -16-31; P = 0.592), rate of return to work (100% vs 100%, P = 1.000), or range of motion (mean difference, 28°; 95%CI, -25-80; P = 0.426). Lunate fractures were not identified in 6 of the 19 radiographs, but were identified in all CT scans. There were no differences in outcome between ARIF and ORIF for the treatment of fresh lunate fracture. The authors recommend surgeons to perform CT scans when diagnosing high-energy wrist trauma so as not to overlook lunate fractures. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Maxime Cievet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Clinique Trenel, 575 Rue du Dr Trenel, 69560, Sainte-Colombe, France.
| | - Marius Buffard
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Ankitha Kumble
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Sonia Ramos-Pascual
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
| | - Marion Burnier
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
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van der Oest MJ, Duraku LS, Artan M, Hundepool CA, Power DM, Rajaratnam V, Zuidam JM. Perilunate Injury Timing and Treatment Options: A Systematic Review. J Wrist Surg 2022; 11:164-176. [PMID: 35478950 PMCID: PMC9038303 DOI: 10.1055/s-0041-1735841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.
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Affiliation(s)
- Mark J.W. van der Oest
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Liron S. Duraku
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Madina Artan
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dominic M. Power
- Department of Birmingham Hand Centre, Queen Elisabeth Hospital, University of Birmingham, Birmingham, United Kingdom
| | | | - J. Michiel Zuidam
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Ribeiro E, Oliveira N, Ribeiro J, Varanda P, Rodrigues LF. Perilunate Lesions – Clinical and Radiological Results with a Minimum of 2 Years of Follow-up. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1729999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractPerilunate 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.
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Affiliation(s)
- Elisabete Ribeiro
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
| | - Nuno Oliveira
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
| | - Juvenália Ribeiro
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
| | - Pedro Varanda
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
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