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Iskandarova A, Dahl AJ, Yohe G, Abbasi P, Carey P, Zimmerman RM. Perilunate Dislocations: Cadaveric Model K-Wire Versus Compression Staple Fixation. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:355-362. [PMID: 38817753 PMCID: PMC11133909 DOI: 10.1016/j.jhsg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/15/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Repair of perilunate dislocations requires stabilization of the carpal bones, although there is limited research on the preferred method(s) of stabilization. We compared the biomechanical characteristics of K-wire versus staple fixation of scapholunate (SL) and lunotriquetral (LT) intervals in the wrist. Methods After creating a grade IV instability model, 20 cadaver wrists were randomized into 2 stabilization model groups using K-wires or surgical staples across the SL and LT intervals. For each ligament, two K-wires or one surgical staple was used to stabilize the proximal carpal row. Each wrist was loaded with 15 N of force and cycled 5,000 times at an angular velocity of 10 rpm. Displacement between bones was measured at different cycles (10, 100, 500, 1,000, 2,000, 3,000, 4,000, and 5,000). A t test was used for comparisons. Results For the LT K-wire group, the average displacement at 10 cycles was 0.08 mm, and at 5,000 cycles, 0.163 mm. For the SL K-wire group, the average displacement at 10 cycles was 0.025 mm, and at 5,000 cycles, 0.129 mm. For the LT and SL staple fixation models, the average shifts at 10 cycles were 0.029 and 0.063 mm, and at 5,000 cycles, 0.098 and 0.176 mm, respectively. No significant difference between the fixation models was found at any interval. Notably, in each group, a similar number of small outliers with higher amounts of displacement was observed. Conclusions Either K-wire or surgical staple stabilization is suitable for perilunate dislocations. The surgical method should be selected based on patient-specific circumstances and the provider's judgment. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Aygul Iskandarova
- The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
| | - Amanda J. Dahl
- The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
- Georgetown University School of Medicine, Washington, DC
| | - Gabriel Yohe
- The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
- MedStar Health Research Institute, Hyattsville, MD
| | - Pooyan Abbasi
- The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
- MedStar Health Research Institute, Hyattsville, MD
| | - Paul Carey
- The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
| | - Ryan M. Zimmerman
- The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
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2
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Zhou JY, Jodah R, Joseph LP, Yao J. Scapholunate Ligament Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:245-267. [PMID: 38817761 PMCID: PMC11133945 DOI: 10.1016/j.jhsg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 06/01/2024] Open
Abstract
Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.
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Affiliation(s)
- Joanne Y. Zhou
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | | | - Lauren P. Joseph
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
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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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4
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Abstract
Carpal dislocations result from sequential disruption of the complex relationship between the bones and ligaments of the wrist. Injuries to the carpus occur via predictable mechanisms, an understanding of which is critical to identify and treat these frequently missed patterns of injury and to avoid the sequela of chronic instability. Lunate dislocations are by far the most common, but isolated dislocation of other carpal bones can also occur. Open reduction and internal fixation still remains the gold standard for treatment regardless of the debate around the specific approaches. These high-energy injuries are associated with significant long-term morbidity even when identified promptly and appropriately treated. This review will focus on the evaluation and management of common forms of carpal dislocations.
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Affiliation(s)
- Nathan Heineman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dang-Huy Do
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ann Golden
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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5
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Andre C, Coursier R, Saab M, Mezel A, Nectoux É, Fron D, Pougès C, Canavese F. Functional and radiologic outcomes of non-displaced scaphoid waist fractures in adolescents approaching skeletal maturity: Comparison between conservative treatment and percutaneous screw fixation. Orthop Traumatol Surg Res 2023:103636. [PMID: 37268156 DOI: 10.1016/j.otsr.2023.103636] [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: 05/06/2022] [Revised: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Treatment of scaphoid waist fractures is generally conservative in children but surgical in adults, given the relatively high risk of non-union in adults. In adolescents, the required therapeutic strategy is less well defined. The objective of this study was to compare the radiographic and clinical parameters, and the rate of complications, between non-surgical orthopedic treatment (OT) and surgical treatment (ST) by percutaneous screw fixation of these fractures in adolescents approaching skeletal maturity. HYPOTHESIS ST of non-displaced scaphoid waist fractures in adolescents allows radiographic union, a functional result and a complication rate comparable to that of ST. METHODS This single-center retrospective study included patients who presented with a non-displaced scaphoid waist fracture, with a chronological age (CA) and a bone age (BA) between 14 and 18 years. Clinical and radiographic parameters and complications were analyzed during the trauma and at one year, including functional scores, between two groups of patients; OT and ST. RESULTS Thirty-seven patients had OT (63.8%) and 21 had ST (36.2%). The median CA was 16 years [14.25-16]. The median BA was 16 years [15;17] according to the Greulich and Pyle method and corresponded to R9 [R7-R10] and U7 [U7;U8] according to the Distal Radius and Ulnar (DRU) classification system. All non-unions were found in the OT group (23.4% vs. 0%, p=0.019). The duration of immobilization (8 weeks) and the number of consultations were higher after OT than ST. Functional scores were lower in patients with non-union after OT (p≤0.002) CONCLUSION: OT of scaphoid waist fractures in adolescents results in a higher rate of non-union than ST, similar to the rate found in adults. Findings from this study recommend a surgical approach by percutaneous screw fixation. LEVEL OF EVIDENCE III; comparative retrospective study.
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Affiliation(s)
- Constance Andre
- Service de chirurgie orthopédique de l'enfant, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, 59000 Lille, France; Service de chirurgie orthopédique de l'enfant, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France.
| | - Raphaël Coursier
- Service de chirurgie orthopédique de l'enfant, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, 59000 Lille, France; Faculté de médecine et de maïeutique, université catholique de Lille, rue du Port, 59800 Lille, France; Service de chirurgie orthopédique, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, 59000 Lille, France
| | - Marc Saab
- Service d'orthopédie-traumatologie, hôpital Roger-Salengro, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France
| | - Aurélie Mezel
- Service de chirurgie orthopédique de l'enfant, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France
| | - Éric Nectoux
- Service de chirurgie orthopédique de l'enfant, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France; Faculté de médecine Henri-Warembourg, université de Lille, avenue Eugène-Avinée, 59120 Loos, France
| | - Damien Fron
- Service de chirurgie orthopédique de l'enfant, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France
| | - Cécile Pougès
- Faculté de médecine et de maïeutique, université catholique de Lille, rue du Port, 59800 Lille, France; Service de chirurgie orthopédique, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, 59000 Lille, France
| | - Federico Canavese
- Service de chirurgie orthopédique de l'enfant, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France; Faculté de médecine Henri-Warembourg, université de Lille, avenue Eugène-Avinée, 59120 Loos, France
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6
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Abstract
Perilunate dislocations (PLD) and perilunate fracture dislocations (PLFD) are high-energy injuries which can result in long-term complications and significant disability. Early identification of these injuries, followed by prompt, appropriate management is key to optimising patient outcomes. Knowledge of the carpal anatomy is essential in order to understand the varied patterns of injury and plan appropriate definitive management. Emergent reduction and close monitoring of the median nerve, followed by prompt stabilisation or repair of the injured structures remain the mainstay of treatment. In this review, we present a summary of the current evidence regarding the identification and management of these complex injuries.
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Affiliation(s)
- Alison Kinghorn
- Department of Trauma and Orthopaedics, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Graham Finlayson
- Department of Trauma and Orthopaedics, Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, UK
| | - Alastair Faulkner
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, DD1 9SY
| | - Nicholas Riley
- Oxford University Hospitals NHS Foundation Trust, Windmill Road, Headington, Oxford, OX3 7HE, UK
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7
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Lebot G, Amouyel T, Hardy A, Chantelot C, Saab M. Perilunate fracture-dislocations: Clinical and functional outcomes at a mean follow-up of 3.3 years. Orthop Traumatol Surg Res 2021; 107:102973. [PMID: 34052510 DOI: 10.1016/j.otsr.2021.102973] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/22/2020] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Perilunate lesions in the carpus are severe injuries whose functional consequences can limit patients' ability to regain their pre-injury activity levels. The aim of this study was to evaluate the outcomes of a series of patients who suffered a perilunate fracture-dislocation and to assess their ability to resume their social and professional activities. HYPOTHESIS After surgical management of this injury, the medium-term functional outcomes will allow patients to return to their pre-injury social and professional activities. MATERIALS AND METHODS This was a single center, retrospective study. Included patients were adults who had suffered a perilunate fracture-dislocation that was treated emergently. The clinical and functional assessment consisted of comparing the mobility and grip strength between the injured and contralateral wrists, determining the functional outcome scores and the resumption of social and professional activities. A radiological assessment was done to look for instability of the proximal row of the carpus, nonunion or necrosis of the carpal bones, loss of carpal height, and presence of carpal osteoarthritis. RESULTS Ten patients were included with a mean follow-up of 39.4 months. The mean flexion/extension arc decreased significantly to 88° (20°-150) which was 55% of the healthy contralateral side (p=0.0026) while the grip strength decreased but not significantly (40.6 Kg vs. healthy side 62.4 Kg, p=0.063). The mean MWS was 58.75 (40-100), the mean PRWE was 32.9 (4-67.5) and the mean QuickDASH was 30.2 (0-77). Six of the ten patients (60%) were able to return to work, although three required occupational reclassifications. Four patients had signs of proximal row instability. There were seven instances of radiocarpal osteoarthritis, two of which were combined with mid-carpal osteoarthritis. DISCUSSION This study found shorter range of motion and worse patient-reported outcomes than other published studies, which may be due to the severity of the perilunate fracture-dislocation injuries and the inclusion of polytrauma patients. Nevertheless, the subjective scores were comparable. These injuries have serious consequences on social and professional activities of manual workers. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Gaspard Lebot
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France
| | - Thomas Amouyel
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France
| | - Alexandre Hardy
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France
| | | | - Marc Saab
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France.
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8
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Quintero JI, Van Royen K, Bouri F, Muneer M, Tien H. Avascular necrosis of the lunate secondary to perilunate fracture dislocation: Case report and review of the literature. SAGE Open Med Case Rep 2021; 9:2050313X211032398. [PMID: 34290873 PMCID: PMC8278458 DOI: 10.1177/2050313x211032398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 06/23/2021] [Indexed: 11/15/2022] Open
Abstract
This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.
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Affiliation(s)
- Jorge I Quintero
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Kjell Van Royen
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Fadi Bouri
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Mohammed Muneer
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Huey Tien
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
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Treatment of acute perilunate dislocation or fracture dislocation using dorsal approach and diamond-shaped Kirschner-wire fixation. Jt Dis Relat Surg 2020; 32:42-50. [PMID: 33463417 PMCID: PMC8073432 DOI: 10.5606/ehc.2021.74838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to evaluate the clinical and radiological outcomes of diamond-shaped Kirschner (K)-wire fixation for the treatment of acute perilunate dislocation (PLD) or trans-scaphoid perilunate fracture dislocation (PLFD). Patients and methods
We performed a retrospective review of 18 patients (18 wrists; 17 males, 1 female; mean age 31.5±2.6 years; range, 18 to 47 years) treated for PLD/PLFD using a dorsal approach with the diamond-shaped K-wire fixation between November 2001 and September 2017. The mean follow-up of cohort was 27 (range, 13 to 74) months. Using a dorsal approach, open ligament repair and bone fixations were performed. Perilunate dislocation was reduced and the carpal bones and midcarpal joint were held in anatomical position using four K-wires transfixing the scapholunate (SL), lunotriquetral, scaphocapitate, and triquetrohamate joints in such a shape that each bone received two K-wires. Results
The mean range of motion and grip strength measured using a Jamar® dynamometer of the injured wrist compared to the uninjured extremity were 84.3% and 78.8%, respectively. The mean Mayo wrist score was 78.3 (range, 70 to 90). The mean Visual Analog Scale score was 1.2 (range, 0 to 4). The average SL gap at the final follow-up evaluation was 1.62 (range, 1 to 2.3) mm. The mean SL and capitolunate angles were 49.3° (range, 40 to 75°) and 4.2° (range, 2 to 12°), respectively. Conclusion
Because every bone is fixed with two K-wires using this configuration, a closed ring is created; hence no motion is possible between the scaphoid, capitate, hamate, triquetrum, lunate and the midcarpal joint. We believe that diamond-shaped fixation may provide reliable fixation and satisfactory clinical outcomes in patients with PLD and PLFD.
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10
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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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11
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Gire JD, Yao J. Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete. Clin Sports Med 2020; 39:313-337. [PMID: 32115087 DOI: 10.1016/j.csm.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.
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Affiliation(s)
- Jacob D Gire
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA
| | - Jeffrey Yao
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA.
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12
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Dunn JC, Koehler LR, Kusnezov NA, Polfer E, Orr JD, Pirela-Cruz MA, Mitchell JS. Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military. J Wrist Surg 2018; 7:57-65. [PMID: 29383277 PMCID: PMC5788754 DOI: 10.1055/s-0037-1603932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Abstract
Background Perilunate dislocations and perilunate fracture dislocations (PLDs/PLFDs) are rare and often associated with poor outcomes. Heretofore, these outcomes have not been evaluated in a high-demand military population. Questions/Purpose The purpose of this study was to evaluate the outcomes in a young, active population after sustaining PLD/PLFD injuries. Patients and Methods We retrospectively reviewed the U.S. military service members who underwent surgical treatment for a PLD/PLFD (Current Procedural Terminology codes 25695 and 25685) between June 1, 2010, and June 1, 2014 through the Military Health System Management Analysis and Reporting Tool (M2) database, capturing patients with a minimum 2-year follow-up. Patient characteristics and outcomes were gathered; however, radiographic analysis was not possible. Results In this study, 40 patients (40 wrists) were included with an average follow-up of 47.8 months. The average age was 28.8 years. Twenty-two injuries (55%) were PLFD and 22 (55%) cases involved the nondominant extremity. On initial presentation, 11 (27.5%) were missed and 50% of patients were presented with acute carpal tunnel syndrome. Range of motion (ROM) was 74% and grip strength was 65% compared with the contralateral wrist; 78% reported pain with activity and only 55% remained on active duty status at final follow-up. Injuries to the nondominant extremity were significantly more likely to experience a good to excellent outcome and regained a more ROM. Patients with ligamentous PLD had less pain at rest and were more likely to return to sport. Conclusion Worse outcomes can be expected for PLD/PLFD of the dominant extremity, transscaphoid PLFD, greater arc injuries, and those undergoing pinning alone. A high-demand patient may expect worse functional results with a higher degree of limitation postoperatively. Level of Evidence The level of evidence is therapeutic IV.
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Affiliation(s)
- John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Logan R. Koehler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Nicholas A. Kusnezov
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Elizabeth Polfer
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Justin D. Orr
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Miguel A. Pirela-Cruz
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Justin S. Mitchell
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
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13
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Abstract
The key to successful treatment of perilunate injuries is to achieve early anatomic reduction and maintain the carpal alignment. Open surgery may lead to capsular scarring and joint stiffness. Furthermore, there is increased chance of damage of the already tenuous blood supply to scaphoid and the torn ligaments. Recently, arthroscopic-assisted management of perilunate injuries has been suggested. This article describes the surgical technique and outcome of this minimally invasive approach for perilunate injuries.
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Affiliation(s)
- Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, 4th Clinical Hospital of Peking University, Beijing 100035, China.
| | - Shan-Lin Chen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, 4th Clinical Hospital of Peking University, Beijing 100035, China
| | - Jin Zhu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, 4th Clinical Hospital of Peking University, Beijing 100035, China
| | - Guang-Lei Tian
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, 4th Clinical Hospital of Peking University, Beijing 100035, China
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14
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Abstract
Management of hand and wrist injuries for athletes often places emphasis on an expeditious return to sport. Arthroscopic techniques have the advantage of directly visualizing joint derangements and correcting them via a minimally invasive approach. This article discusses the evaluation and management of common wrist injuries treated with arthroscopy in athletes, including scapholunate and lunotriquetral injury, triangular fibrocartilage complex tears, hamatolunate impingement, and arthroscopic-assisted reduction of wrist fractures.
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Muller T, Hidalgo Diaz JJ, Pire E, Prunières G, Facca S, Liverneaux P. Treatment of acute perilunate dislocations: ORIF versus proximal row carpectomy. Orthop Traumatol Surg Res 2017; 103:95-99. [PMID: 27923762 DOI: 10.1016/j.otsr.2016.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Some authors have proposed performing proximal row carpectomy (PRC) as the initial treatment for perilunate dislocations. HYPOTHESIS The goal of this retrospective study was to compare the results of a cohort of perilunate dislocation cases that were operated by open reduction and internal fixation (ORIF) or by PRC between 2006 and 2011. METHODS The cohort consisted of 21 men with a mean age of 33years, who either had an isolated perilunate dislocation (7 cases) or a fracture-dislocation (14 cases). All dislocations were dorsal, with 10 stage I and 12 stage II. Thirteen patients had been treated by ORIF (group 1) a mean of 1.2days after the injury. Eight patients had been treated by PRC (group 2) a mean of 18.7days after the injury. Immobilization time was 6-12weeks in group 1 and 2weeks in group 2. RESULTS The mean operative time was 95minutes in group 1 and 65minutes in group 2. After a mean follow-up of 35months, the following outcomes were found for groups 1 and 2, respectively: pain 3/10 and 1/10, strength 77% and 73%, strength in supination 79% and 93%, strength in pronation 67% and 95%, QuickDASH 27/100 and 16/100, PRWE 43/150 and 15.5/150, flexion 69% and 57%, extension 84% and 58%, pronation 97% and 103%, supination 98% and 97%. There were four cases of osteoarthritis in both groups. CONCLUSION Treatment of acute perilunate dislocations by PRC leads to medium-term results that are at least as good as those with ORIF treatment. The surgery duration is shorter with PRC, as is the immobilization period. TYPE OF STUDY Retrospective comparative. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T Muller
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - J J Hidalgo Diaz
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - E Pire
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - G Prunières
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - S Facca
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - P Liverneaux
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France.
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Comparative Outcome Analysis of Arthroscopic-Assisted Versus Open Reduction and Fixation of Trans-scaphoid Perilunate Fracture Dislocations. Arthroscopy 2017; 33:92-100. [PMID: 27707581 DOI: 10.1016/j.arthro.2016.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare union rates and clinical and radiological outcomes of arthroscopic-assisted reduction and fixation with those of open reduction and fixation in patients with trans-scaphoid perilunate fracture dislocations. METHODS This retrospective study included consecutive patients with trans-scaphoid PLFDs who underwent arthroscopic-assisted reduction and fixation (group A) or open reduction and fixation (group O), and who were followed up for a minimum of 2 years between May 2005 and March 2013. We excluded initially missed patients. Each different surgeon who was on call had performed each experienced operation. These clinical outcomes were assessed: range of motion, grip strength, Mayo wrist score, and Disabilities of Arm, Shoulder, and Hand (DASH) score. For radiologic outcomes, the scapholunate angle, radiolunate angle, and lunotriquetral distance were measured. RESULTS The total number of included patient was 20 (11 in group A and 9 in group O). Scaphoid union occurred in all patients except 1 individual (11 of 11 in group A, and 8 of 9 in group O). At the last follow-up, the mean flexion-extension arc was significantly greater in group A (125.0°) than in group O (105.6°) (P = .028). The mean grip strength was 81.1% that of the contralateral side in group A and 80.9% in group O (P = .594). The mean Mayo wrist score was 85.5 in group A and 79.4 in group O (P = .026), and the mean DASH score was 10.6 in group A and 20.8 in group O (P = .001); however, only the DASH score showed a minimum clinically important difference. The mean scapholunate angle, radiolunate angle, and lunotriquetral distance were similar between the 2 groups: 47.2°, 1.7°, and 2.0 mm in group A and 48.8°, 5.6°, and 2.1 mm in group O, respectively. CONCLUSIONS Although both arthroscopic and open techniques achieved stability of the injured wrists in patients with trans-scaphoid PLFDs, it is shown that the arthroscopic-assisted technique showed a clinically meaningful better DASH score and greater flexion-extension arc with other parameters being similar. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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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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Griffin M, Roushdi I, Osagie L, Cerovac S, Umarji S. Patient-Reported Outcomes Following Surgically Managed Perilunate Dislocation: Outcomes After Perilunate Dislocation. Hand (N Y) 2016; 11:22-8. [PMID: 27418885 PMCID: PMC4920520 DOI: 10.1177/1558944715617222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perilunate dislocations (PLDs) are uncommon high-energy injuries that may result in significant morbidity if inadequately treated. We report the midterm outcomes following surgical intervention and the validity of the Patient-Rated Wrist Evaluation (PRWE) score as an assessment tool post injury. METHODS We prospectively present outcomes in 16 patients with perilunate injuries. Definitive surgical management comprised fixation of all fractures and anatomical reconstruction of ruptured ligaments where possible. All patients completed the Disabilities of the Arm, Shoulder and Hand (DASH), 12-Item Short-Form Health Survey, and PRWE, for which internal consistency and construct validity were assessed. RESULTS At 24 months, the mean grip strength was 59% of the uninjured side (range 33%-85%) and the mean range of flexion was 71% and extension was 58%. Eighty-eight percent of patients returned to work within 6 months and 63% to sport within 1 year. The PRWE score was 36.2 (range 14.5-77.3) and DASH 25.2 (range 7.5-91.7). The mean visual analog scale (VAS) satisfaction score was 7.9 (range 0-10), VAS pain at rest 1.9 (range 0-6) and on activity 3.3 (range 1-6). DASH and PRWE demonstrated similar internal consistencies with Cronbach alphas of .98 and .91, respectively, and a strongly positive correlation coefficient of r = +.7 (P < .05). CONCLUSIONS Surgical treatment of PLDs can provide good clinical outcomes allowing patients to return to normal activities in a reasonable timescale when delays to surgery are kept to a minimum. The PRWE demonstrated high internal consistency and was found to be a valid questionnaire with advantages over the DASH for use following severe carpal injures.
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Affiliation(s)
| | | | | | | | - Shamim Umarji
- St Georges Healthcare, London, UK,Shamim Umarji, Department of Orthopaedic Surgery, St Georges Healthcare Trust, Tooting London, 0208 6721255, UK.
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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.
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Affiliation(s)
- Raghuveer C Muppavarapu
- Division of Hand Surgery, NYU Hospital for Joint Diseases, New York University School of Medicine, 530 First Avenue, Suite 8U, New York, NY 10016, USA
| | - John T Capo
- Division of Hand Surgery, NYU Hospital for Joint Diseases, New York University School of Medicine, 530 First Avenue, Suite 8U, New York, NY 10016, USA.
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Moody L, Zhang AY. Treatment of an unusual trans-scaphoid perilunate avulsion fracture dislocation: a case report. Hand (N Y) 2015; 10:328-32. [PMID: 26034454 PMCID: PMC4447658 DOI: 10.1007/s11552-014-9634-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe an unusual case of trans-scaphoid perilunate injury where the proximal half of the scaphoid avulsed from all attaching ligaments and extruded into the forearm. Treatment involved anatomic reduction and internal fixation of the fracture, scapholunate (SL) ligament repair, temporary K-wire fixation, and prolonged immobilization. At 19-month follow-up, the fracture healed, SL ligament remained intact, and the patient recovered much of his hand function.
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Affiliation(s)
- Lisa Moody
- Division of Plastic and Reconstructive Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0724 USA
| | - Andrew Y. Zhang
- Division of Plastic and Reconstructive Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0724 USA
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Meijer ST, Janssen SJ, Drijkoningen T, Ring D. Factors associated with unplanned reoperation in perilunate dislocations and fracture dislocations. J Wrist Surg 2015; 4:88-92. [PMID: 25945292 PMCID: PMC4408134 DOI: 10.1055/s-0035-1550161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background Perilunate injuries are complex and uncommon injuries that are typically the result of a high-energy injury and are nearly always treated operatively. Little is known about factors associated with unplanned reoperations after surgery for perilunate injuries. Purpose To assess the rate and types of unplanned reoperation after operative treatment of a perilunate dislocation. Patients and Methods We reviewed 115 patients of all ages with unplanned reoperations after operative treatment of perilunate injuries at five hospitals. Planned removal of implants were not considered as unplanned reoperations. Results Sixteen patients had an unplanned reoperation, including four for compartment syndrome (three hand, one forearm); three for deep infection; three for malalignment or an errant screw; two for early salvage procedures; and four for other reasons. We considered seven unplanned reoperations necessary (forearm compartment syndrome, infection, loss of alignment, errant screw) and nine debatable or unnecessary (hand compartment syndrome, early salvage procedures, suspected malunion, etc.). Patients who had an unplanned reoperation were younger (median age 24 versus 34 years; p = 0.0034); had earlier surgery (median days to surgery 0 versus 3; p = 0.0068); and were more likely injured in a motor vehicle collision (50% versus 17%; p = 0.0070). Accounting for interaction among the variables using multivariable analysis, the factors independently associated with unplanned reoperation were young age (odds ratio 0.92) and motor vehicle collision accidents (odds ratio 4.1). Conclusion We conclude that higher-energy injuries may be at greater risk for unplanned reoperation, but more than half of the unplanned reoperations were for debatable indications. Level III Retrospective Cohort Review.
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Affiliation(s)
- Sjoerd Th. Meijer
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts
| | - Stein J. Janssen
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts
| | - Tessa Drijkoningen
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts
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Abstract
Background The key to a successful result in the treatment of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) is the restoration of normal alignment of the carpal bones, followed by stable maintenance until healing. This article aimed to assess whether arthroscopic techniques are a reliable surgical option for the treatment of this challenging injury. Materials and Methods Twenty patients with an acute PLD or PLFD were treated by an arthroscopic technique. They were retrospectively reviewed at an average follow-up of 31.2 months (range 18-61 months). Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) score as well as radiographic evaluations. Description of Technique Arthroscopic reduction and percutaneous fixation was performed to the scapholunate and lunotriquetral intervals using Kirschner wires (K-wires) as joysticks as well as to the scaphoid using a cannulated headless screw for transscaphoid-type injuries. The K-wires were removed at 10 weeks postoperation. Results Overall functional outcomes according to the MMWS were rated as excellent in three patients, good in eight, fair in seven, and poor in two. The mean DASH score was 18, and the mean PRWE score was 30. On the basis of radiographic parameters, reduction obtained at the operation was maintained within normal ranges in 15 patients. No patient had developed arthritis by the last follow-up. Conclusions The medium-term results show that arthroscopic treatment can provide proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes for acute perilunate injuries. Level of Evidence Level IV.
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Affiliation(s)
- Jong Pil Kim
- Department of Orthopedic Surgery, College of Medicine, Graduate School of Dankook University, Cheonan, Korea
- Department of Kinesiology and Medical Science, Graduate School of Dankook University, Cheonan, Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Medical Center, Chung-Ang University, Seoul, Korea
| | - Min Jong Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Liu B, Chen SL, Zhu J, Wang ZX, Shen J. Arthroscopically assisted mini-invasive management of perilunate dislocations. J Wrist Surg 2015; 4:93-100. [PMID: 25945293 PMCID: PMC4408130 DOI: 10.1055/s-0035-1550162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Purpose The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Methods Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture-dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range 6-32 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 (QuickDASH) questionnaire; and Patient-Rated Wrist Evaluation (PRWE) score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. Results The range of flexion-extension motion of the injured wrist averaged 86% of the values for the contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean QuickDASH score was 6, and the mean PRWE score was 10. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in one patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Conclusions Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. LEVEL OF EVIDENCE Level IV, Therapeutic.
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Affiliation(s)
- Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
- The fourth Clinical College of Peking University, Beijing, China
| | - Shan-Lin Chen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
- The fourth Clinical College of Peking University, Beijing, China
| | - Jin Zhu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
- The fourth Clinical College of Peking University, Beijing, China
| | - Zhi-Xin Wang
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
- The fourth Clinical College of Peking University, Beijing, China
| | - Jie Shen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
- The fourth Clinical College of Peking University, Beijing, China
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Savvidou OD, Beltsios M, Sakellariou VI, Papagelopoulos PJ. Perilunate dislocations treated with external fixation and percutaneous pinning. J Wrist Surg 2015; 4:76-80. [PMID: 25945290 PMCID: PMC4408135 DOI: 10.1055/s-0035-1550159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Background The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) treated with external fixation and Kirschner wires (K-wires). Materials and Methods Twenty patients (18 males and 2 females) with a mean age of 38 years (range 18-59) with an acute PLD or PLFD were treated with external fixator and K-wires. There were 12 PLDs and seven transscaphoid and one transstyloid PLFDs. The median time from trauma to operation was 8 hours (range 2-12 hours). Indirect reduction via ligamentotaxis was achieved in 17 patients with a mean age of 38years (range 18-59). There were 12 PLDs and 5 trans-scaphoid PLFDs; however, in three cases (two transscaphoid and one transstyloid PLFDs), indirect reduction failed and an open reduction was required. The intercarpal ligaments were not repaired even after open reduction. Results The mean follow-up was 39 months (range 18-68 months). The flexion-extension range of motion (ROM) and grip strength of the injured wrist averaged 80% and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney's scoring system, overall functional outcomes of the 17 patients were rated as excellent in 4 patients, good in 8, fair in 4, and poor in 1. Fifteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid, and two developed posttraumatic arthritis. Conclusion External fixation plus percutaneous K-wires for the treatment of acute PLDs has satisfactory midterm functional and radiographic outcomes. When successful, this minimally invasive technique is simple and provides restoration of the carpal alignment. It may especially be useful in the polytrauma patient, thanks to its decreased operative time and diminished blood loss, when other emergent surgical procedures may be necessary. An open reduction with possible fixation may be necessary for PLDs and PLFDs, especially in the presence of polytrauma and scaphoid comminution. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Olga D. Savvidou
- 1st Department of Orthopaedics, Athens University Medical School, ATTIKON University General Hospital, Chaidari, Greece
| | - Michael Beltsios
- Department of Orthopaedics, Thriassio General Hospital, Magoula, Greece
| | - Vasileios I. Sakellariou
- 1st Department of Orthopaedics, Athens University Medical School, ATTIKON University General Hospital, Chaidari, Greece
| | - Panayiotis J. Papagelopoulos
- 1st Department of Orthopaedics, Athens University Medical School, ATTIKON University General Hospital, Chaidari, Greece
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Affiliation(s)
- Tom Reisler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ
| | - Paul J Therattil
- Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ
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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]
Affiliation(s)
- Mark A Vitale
- ONS Foundation for Clinical Research and Education, Greenwich; Greenwich Hospital, Yale-New Haven Health, New Haven, CT; Newton-Wellesley Hospital, Newton; Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA
| | - Mani Seetharaman
- ONS Foundation for Clinical Research and Education, Greenwich; Greenwich Hospital, Yale-New Haven Health, New Haven, CT; Newton-Wellesley Hospital, Newton; Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA
| | - David E Ruchelsman
- ONS Foundation for Clinical Research and Education, Greenwich; Greenwich Hospital, Yale-New Haven Health, New Haven, CT; Newton-Wellesley Hospital, Newton; Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA.
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Samson D, Power DM. Perilunate dislocation in an asymptomatic SNAC wrist: an uncommon presentation requiring a scaphoidectomy and four corner fusion. BMJ Case Rep 2014; 2014:bcr-2014-207658. [PMID: 25422346 DOI: 10.1136/bcr-2014-207658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This report describes a 53-year-old man who presented, following a motocross injury, with a Mayfield stage 1 perilunate dislocation through a pre-existing asymptomatic scaphoid non-union with a degenerative midcarpal joint. A salvage reconstruction with scaphoid excision and four corner midcarpal arthrodesis resulted in a satisfactory outcome. Follow-up at 6 years demonstrated no instability and no further progression of the osteoarthritis.
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Abstract
OBJECTIVE The article reviews a select group of traumatic upper extremity injuries that can be easily misinterpreted on radiographs. CONCLUSION The awareness of these specific injuries and an understanding of their underlying pathophysiology and the role that radiographs can play in their evaluation will give the reader the best opportunity to make the important imaging findings and guide appropriate treatment.
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Savvidou OD, Beltsios M, Sakellariou VI, Mavrogenis AF, Christodoulou M, Papagelopoulos PJ. Use of external fixation for perilunate dislocations and fracture dislocations. Strategies Trauma Limb Reconstr 2014; 9:141-8. [PMID: 25301167 PMCID: PMC4278973 DOI: 10.1007/s11751-014-0201-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/05/2014] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation. Twenty patients (18 males and two females) with a mean age of 38 years (range 18–59) who had an acute dorsal perilunate dislocation or fracture dislocation were treated with the use of wrist external fixator and K-wires. The injuries included 12 perilunate dislocations, seven trans-scaphoid perilunate fracture dislocations, and one trans-styloid perilunate fracture dislocation. The median time from trauma to operation was 8 h (2–12 h). Indirect reduction via ligamentotaxis was achieved in all perilunate dislocation, and provisional K-wire fixation was added. In five of seven trans-scaphoid perilunate fracture dislocations, indirect reduction was achieved; whereas in the other two as well as in the case of trans-styloid perilunate fracture dislocation, open reduction was required. External fixator was supplemented with K-wires for stabilization of the fractures and the intercarpal intervals. The interosseous and capsular ligaments were not repaired, even after open reduction of fracture dislocations. The mean follow-up was 39 months (range 18–68 months). Range of motion and grip strength were measured. Cooney’s scoring system was used for the assessment of clinical function. Radiographic evaluation included time to scaphoid union, measurement of radiographic parameters (scapholunate gap, scapholunate angle, lunotriquetral gap, and carpal height ratio) and any development of arthritis. The flexion-extension motion arc and grip strength of the injured wrist averaged 80 and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney’s clinical scoring system, overall functional outcomes were rated as excellent in four patients, good in eight, fair in six, and poor in two. Eighteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid; one of them required scaphoid excision and midcarpal fusion. Two patients had radiographic evidence of arthritis. The use of external fixation and provisional K-wire fixation for the treatment of acute perilunate dislocations is associated with satisfactory midterm functional and radiographic outcomes. This minimally invasive treatment option is simple, reliable, and minimally invasive method that provides proper restoration and stable fixation of carpal alignment.
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Affiliation(s)
- Olga D Savvidou
- Department of Orthopaedics, Athens University Medical School, General University Hospital 'ATTIKON', 1 Rimini Street, 12462, Haidari, Greece,
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Toby EB, McGoldrick E, Chalmers B, McIff T. Rotational stability for intercarpal fixation is enhanced by a 4-tine staple. J Hand Surg Am 2014; 39:880-7. [PMID: 24650459 DOI: 10.1016/j.jhsa.2014.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the torsional stability of 6 fixation techniques for intercarpal fixation including a 4-tine, in-line staple. METHODS We chose the scapholunate interval as the test site for rotational stability for various constructs. We used 42 pairs of embalmed scaphoids and lunates for the comparisons and created 6 construct groups. Fixation of the scapholunate gap was performed with a 3-mm screw, 2 1.1-mm (0.045-inch) K-wires spaced 2 mm apart, or 2 1.1-mm K-wires spaced 5 mm apart. One member of each pair was fixed with either a standard 2-tine peripherally placed staple or a customized 4-tine staple. Each scapholunate construct was tested in torsion to failure on a biaxial materials testing machine. RESULTS In all cases, the 4-tine staple significantly increased rotational stability. The 2-tine staple resulted in statistically insignificant increases in rotational stability. With central fixation alone, K-wires separated by 5 mm showed the greatest resistance to torsion, and the 3-mm screw showed the least. CONCLUSIONS Use of an in-line, 4-tine staple provided increased rotational stability and may result in enhanced healing of intercarpal ligamentous reconstructions and arthrodeses. CLINICAL RELEVANCE A 4-tine staple compared with a standard staple provided superior rotational stability for intercarpal fixation.
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Affiliation(s)
- E Bruce Toby
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS.
| | - Erik McGoldrick
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Brian Chalmers
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Terence McIff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
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Acute proximal row carpectomy to treat a transscaphoid, transtriquetral perilunate fracture dislocation: case report and review of the literature. Hand (N Y) 2013; 8:105-9. [PMID: 24426904 PMCID: PMC3574483 DOI: 10.1007/s11552-012-9462-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sawardeker PJ, Kindt KE, Baratz ME. Fracture-dislocations of the carpus: perilunate injury. Orthop Clin North Am 2013; 44:93-106. [PMID: 23174329 DOI: 10.1016/j.ocl.2012.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The progressive perilunar instability model described by Mayfield is still used to predict the pattern of injury. Diagnosis of injury and clinical and radiographic findings depend on the pattern of injury. Open procedures are preferred for anatomic reduction after initial closed reduction is performed for acute injuries. A dorsal, volar, or combined dorsal/volar approach may be necessary and is often decided by surgeon preference. Loss of motion and diminished grip strength are common consequences despite appropriate treatment. Successful outcomes depend on time to treatment, open or closed nature of injury, extent of chondral damage, residual instability, and fracture union.
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Affiliation(s)
- Prasad J Sawardeker
- Orthopedic Surgery Department, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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Jones DB, Kakar S. Perilunate dislocations and fracture dislocations. J Hand Surg Am 2012; 37:2168-73; quiz 2174. [PMID: 22960028 DOI: 10.1016/j.jhsa.2012.07.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/29/2012] [Indexed: 02/02/2023]
Abstract
Perilunate dislocations and fracture dislocations are high-energy injuries that can result in pain, stiffness, weakness, or disability if inappropriately treated. Prompt recognition and surgical treatment with anatomic reduction of carpal malalignment improve the likelihood of optimal, long-term clinical success and patient satisfaction. The progressive development of radiographic evidence of arthrosis is common but has not been shown to consistently correlate with worse patient function and outcomes.
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Affiliation(s)
- David B Jones
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Reichel LM, Bell BR, Michnick SM, Reitman CA. Radial styloid fractures. J Hand Surg Am 2012; 37:1726-41. [PMID: 22835591 DOI: 10.1016/j.jhsa.2012.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 02/02/2023]
Abstract
Radial styloid fractures can occur in isolation or in association with other injuries, including complex intra-articular distal radius fractures, carpal fractures, carpal dislocations, and radiocarpal dislocations. The anatomy surrounding the radial styloid is complex, and complications related to surgical approach, treatments, and symptomatic hardware can occur. Operative treatments vary according to the injury pattern present, and pattern recognition is the key to optimizing treatment of these injuries. Outcomes are related to the precision of the reconstruction as well as the magnitude of the injury; better results are associated with lower-energy patterns.
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Affiliation(s)
- Lee M Reichel
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA.
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Perilunate injuries. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31825fa691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Garg B, Goyal T, Kotwal PP. Staged reduction of neglected transscaphoid perilunate fracture dislocation: a report of 16 cases. J Orthop Surg Res 2012; 7:19. [PMID: 22607705 PMCID: PMC3489547 DOI: 10.1186/1749-799x-7-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 05/02/2012] [Indexed: 12/02/2022] Open
Abstract
Background Transscaphoid perilunate fracture dislocation is a rare injury and can be easily missed at the initial treatment. Once ignored, late reduction is not possible and needs extensive dissection. An alternative treatment such as proximal row carpectomy may be required for neglected injuries, but surgical outcome is not as good as that of an early reduction. We aim to present an alternative technique of staged reduction and fixation in patients of neglected transscaphoid perilunate dislocations and study its outcome. Material & Methods 16 cases (14 males & 2 females) with neglected transscaphoid perilunate fracture dislocation (> 3 month old) were treated with staged reduction. Mean duration between injury and surgery was 4.5 months. In first stage an external fixator was applied across the wrist and distraction was done at 1 mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation. Results The mean duration between two surgeries was 2.4 weeks (range 2–4 weeks). 9 cases had excellent results, 5 had good result. Two patients developed reflex sympathetic dystrophy and had fair results. Conclusion Staged reduction should be considered for neglected transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, 110029, New Delhi, India
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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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Kim JP, Lee JS, Park MJ. Arthroscopic reduction and percutaneous fixation of perilunate dislocations and fracture-dislocations. Arthroscopy 2012; 28:196-203.e2. [PMID: 22130497 DOI: 10.1016/j.arthro.2011.08.299] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopic reduction and percutaneous fixation. METHODS Twenty patients who had an acute dorsal perilunate dislocation or fracture-dislocation were treated with an arthroscopic technique at a median interval of 3.9 days from the time of injury. They were retrospectively reviewed at a mean follow-up of 31.2 months (range, 18 to 61 months). Range of motion and grip strength were measured. Radiographic evaluations included time to scaphoid union, measurement of radiologic parameters, and any development of arthritis. Functional outcomes were determined by the modified Mayo wrist score; Disabilities of the Arm, Shoulder and Hand questionnaire; and Patient-Rated Wrist Evaluation score. RESULTS The flexion-extension motion arc and grip strength of the injured wrist averaged 79% and 78%, respectively, of the corresponding values for the contralateral wrists. The mean Disabilities of the Arm, Shoulder and Hand score was 18, and the mean Patient-Rated Wrist Evaluation score was 30. According to modified Mayo wrist scores, overall functional outcomes were rated as excellent in 3 patients, good in 8, fair in 7, and poor in 2. Nonunion developed in 2 patients with a trans-scaphoid perilunate injury; 1 of the 2 underwent scaphoid excision and midcarpal fusion. On the basis of radiographic parameters, reduction obtained during the operation was maintained within normal ranges in 15 patients. Arthritis had not developed in any patient by the last follow-up. CONCLUSIONS This study suggests that arthroscopic reduction with percutaneous fixation is a reliable minimally invasive surgical method for acute perilunate injuries in that it provides proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes on a midterm basis. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jong Pil Kim
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Abstract
Perilunate dislocations and perilunate fracture-dislocations usually result from high-energy traumatic injuries to the wrist and are associated with a characteristic spectrum of bony and ligamentous damage. Radiographic evaluation of the wrist reveals loss of normal radiocarpal and intercarpal colinearity and bony insult, which may be overlooked at the initial presentation. Prompt recognition is important to optimize outcomes. Closed reduction is performed acutely, followed by open reduction and ligamentous and bony repair with internal fixation. Complications include posttraumatic arthrosis, median nerve dysfunction, complex regional pain syndrome, tendon problems, and carpal instability. Despite appropriate treatment, loss of wrist motion and grip strength, as well as persistent pain, is common. Medium- and long-term studies demonstrate radiographic evidence of midcarpal and radiocarpal arthrosis, although this does not correlate with functional outcomes.
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Carelsen B, van Loon J, Streekstra GJ, Maas M, van Kemenade P, Strackee SD. First experiences with the use of intraoperative 3D-RX for wrist surgery. MINIM INVASIV THER 2011; 20:160-6. [PMID: 21250915 DOI: 10.3109/13645706.2010.518807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
With the use of conventional C-arm fluoroscopy for hand surgery, suboptimal positioning of implants, K-wires, insufficient reconstructions and joint incongruities frequently remain unrevealed We prospectively compared the performance of the surgeon interpreted from conventional methods (2D fluoroscopy and direct visual and physical inspection) versus 3D imaging as well as the occurrence of revision surgeries based on post-op radiological findings. Twenty-four intraoperative findings based on 2D fluoroscopy and findings on direct visual and physical inspections were compared with intraoperatively acquired 3D-RX scans by means of a questionnaire. Moreover, record was kept of revision surgery (minimal three months follow up) for all patients treated with the aid of 3D-RX. A clear difference in findings was observed between the performance based on fluoroscopy and direct visual and physical inspection and that based on intraoperative 3D-RX for hand surgery (p < 0.05). Post-operative radiological examinations revealed that none of the 56 patients treated with the aid of 3D-RX needed revision surgery. Intraoperative 3D-RX provides information for the hand surgeon that is additional to the information acquired with conventional fluoroscopy. Intraoperative 3D-RX provides well defined images of the positioning of osteosynthesis material, of the spatial orientation of carpals, and of reconstruction of the wrist joint.
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Affiliation(s)
- Bart Carelsen
- Dept. Medical Physics, Academic Medical Center, Amsterdam, The Netherlands
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Kremer T, Wendt M, Riedel K, Sauerbier M, Germann G, Bickert B. Open reduction for perilunate injuries--clinical outcome and patient satisfaction. J Hand Surg Am 2010; 35:1599-606. [PMID: 20888496 DOI: 10.1016/j.jhsa.2010.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 06/12/2010] [Accepted: 06/17/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Perilunate injuries cause severe carpal malalignment. Open reduction and internal fixation of these injuries has become the treatment of choice. This study evaluated clinical outcome and the patients' perception of disability in activities of daily living after open reduction, ligament reconstruction, and/or internal fixation of the scaphoid. In addition, potential prognostic factors for functional outcome and individual perceptions of disability were analyzed and compared with radiologic findings. METHODS This study consisted of a retrospective analysis of patients with perilunate dislocations or fracture dislocations (Mayfield stage 3/4) who were treated in a single institution from 1995 to 2004. Evaluation focused on postoperative radiologic results, range of motion, pain, sensitivity, grip strength, Mayo and Krimmer wrist scores, arthrosis, and the patients' disability in performing activities of daily living (according to the Disabilities of the Arm, Shoulder, and Hand score). RESULTS Of the 72 patients treated in the study period, 39 patients (all men) were available for complete follow-up (average, 65.5 mo). Thirty injuries were fracture dislocations; the dominant hand was injured in 14 cases. Normal scapholunate (SL) angles and Gilula arcs were achieved intraoperatively in 34 and 25 cases, respectively. At follow-up, 18 patients had larger than normal SL angles, and 6 patients had ulnar shifting of the carpus. Twenty patients were diagnosed with radiocarpal arthrosis. According to the Visual Analog Scale, pain was 1.8 at rest and 4.8 with activities. Average extension/flexion was 77°; radial/ulnar abduction was reduced to 42°. Average grip strength was reduced to an average of 36.6 kg (compared with 51.6 kg on the opposite side). Twenty-seven patients returned to their former occupations. Average Mayo and Krimmer wrist scores were both 70. The average Disabilities of the Arm, Shoulder, and Hand score was 23. CONCLUSIONS Satisfactory results can be achieved with open reduction for perilunate injuries. However, despite this treatment, loss of reduction and arthrosis are frequent findings. Radiologic results do not necessarily correlate with functional outcome; high patient satisfaction was observed in this study. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Thomas Kremer
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, The University of Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen, Germany.
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Lutz M, Arora R, Kammerlander C, Gabl M, Pechlaner S. Die Versorgung von perilunären Luxationen und Luxationsfrakturen über einen kombinierten palmaren und dorsalen Zugang. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 21:442-58. [DOI: 10.1007/s00064-009-1906-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F. Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up. J Hand Surg Am 2010; 35:62-8. [PMID: 19931988 DOI: 10.1016/j.jhsa.2009.09.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 08/27/2009] [Accepted: 09/03/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Perilunate dislocations and transscaphoid perilunate fracture dislocations are associated with a high incidence of posttraumatic arthritis. According to the current literature, at medium-term follow-up, radiological signs of arthritis do not correlate with functional scores. The aim of this study was to evaluate patient hand function and the development of posttraumatic arthritis after perilunate dislocations (11 cases) and transscaphoid perilunate fracture dislocations (7 cases) at a minimum 10 years of follow-up. METHODS A retrospective review was performed including 18 patients with a minimum 10-year (average, 13 y) follow-up. The clinical results were evaluated using the Mayo wrist score and the patient-rated wrist evaluation. Radiological abnormalities were stratified using the Herzberg classification. RESULTS According to the Mayo wrist score, the authors found 5 excellent, 3 good, 7 fair, and 3 poor results. The mean Mayo wrist score was 76 (range, 60-90). There were 6 type A, 5 type A1, 6 type B1, and 1 type C, according to the Herzberg classification. Posttraumatic degenerative changes were observed in 12 cases. CONCLUSIONS The presence of radiological arthritis and static carpal instability did not cause reduced function at our minimum follow-up of 10 years. Based on our findings and previously reported series, we conclude that signs of posttraumatic arthritis after perilunate dislocations and transscaphoid perilunate fracture dislocations increase progressively but are well tolerated at an average follow-up of 13 years. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Wong TC, Ip FK. Minimally invasive management of trans-scaphoid perilunate fracture-dislocations. ACTA ACUST UNITED AC 2009; 13:159-65. [PMID: 19378360 DOI: 10.1142/s0218810408004018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 12/07/2008] [Indexed: 11/18/2022]
Abstract
This retrospective study evaluates the functional and radiological results of a series of acute trans-scaphoid dorsal perilunate fracture-dislocations treated operatively by minimally invasive technique. Twenty-one patients had surgery performed by one of three surgeons between 1994 and 2006, and all cases involved: (1) closed reduction of the carpus; (2) closed reduction and percutaneous screw fixation of the scaphoid fracture; and (3) closed reduction and multiple Kirschner wire stabilisation of the carpal dissociation. Seventeen males and four females with an average age of 29 years were evaluated. Ninety five per cent of internally fixed scaphoid healed at a mean time of 16 weeks. Radiographic alignment of the carpus was satisfactory in 17 cases. The average Mayo wrist score was 80 with three excellent and two poor results. There was one patient with asymptomatic DISI deformity. Two patients had radiographic evidence of mid-carpal arthritis. One patient with a scaphoid nonunion required surgical repair with bone grafting. The results of this study suggest that a minimally invasive technique for treating acute trans-scaphoid perilunate fracture-dislocations can be considered as an alternative to open approaches.
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Affiliation(s)
- Tak-Chuen Wong
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
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Yamabe E, Nakamura T, Matsumura T, Toyama Y. Re: Palmar dislocation of the scaphoid with dorsal perilunate dislocation. J Hand Surg Eur Vol 2008; 33:682-3. [PMID: 18977844 DOI: 10.1177/1753193408092493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E. Yamabe
- Department of Orthopaedic Surgery, School of Medicine, Keio
University, 35 Shinanomachi, Shinjukuku, Tokyo 160–8582, Japan E
mail:
| | - T. Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio
University, 35 Shinanomachi, Shinjukuku, Tokyo 160–8582, Japan E
mail:
| | - T. Matsumura
- Department of Orthopaedic Surgery, School of Medicine, Keio
University, 35 Shinanomachi, Shinjukuku, Tokyo 160–8582, Japan E
mail:
| | - Y. Toyama
- Department of Orthopaedic Surgery, School of Medicine, Keio
University, 35 Shinanomachi, Shinjukuku, Tokyo 160–8582, Japan E
mail:
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Abstract
Acute lunate and perilunate dislocations are uncommon but devastating carpal injuries with a guarded prognosis. This article outlines the pathoanatomy, diagnosis, indications for treatment, technique, and expected results of open reduction and internal fixation.
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