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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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Campano D, Rush K, Gottlich C, Jain N, Bourland B, Mckee D. Dorsal lunate dislocation and en bloc proximal row carpectomy: a case report. J Surg Case Rep 2024; 2024:rjae043. [PMID: 38328456 PMCID: PMC10847405 DOI: 10.1093/jscr/rjae043] [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: 12/03/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
An unhelmeted 59-year-old male involved in a motorcycle accident presented with a right dorsal lunate dislocation in the context of a polytrauma evaluation. Soft-tissue attachments were minimal across the carpus, which allowed for an en bloc proximal row carpectomy. Two-year follow-up yielded a satisfactory outcome given the high energy injury mechanism. Proximal row carpectomy is a useful tool which preserves wrist range of motion in the acute trauma setting and is durable, as demonstrated by our patient's postoperative mobilization using a wheelchair.
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Affiliation(s)
- Dominic Campano
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Kaitlin Rush
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Caleb Gottlich
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Neil Jain
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Bryan Bourland
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Desirae Mckee
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
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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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Tomczak S, Abellan Lopez M, Jaloux C, Legre R, Bertrand B, DE Villeneuve Bargemon JB. Immediate Proximal Row Carpectomy for Severe Perilunate Dislocation Injuries: A Minimum 5-Year Follow-Up. J Hand Surg Asian Pac Vol 2023; 28:382-387. [PMID: 37501545 DOI: 10.1142/s2424835523500467] [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] [Indexed: 07/29/2023]
Abstract
Background: In patients with perilunate injuries (PLI) with multiple ligamentous and bony injuries involving the proximal carpal row, open reduction and internal fixation (ORIF) can be difficult and lead to poor functional outcomes. Proximal row carpectomy (PRC) is an alternative procedure that has been used for severely comminuted fractures. The aim of our study is to evaluate the long-term functional outcome (minimum 5 years) of patients that underwent an emergency PRC for PLI. Methods: We conducted a retrospective study of patients who underwent PRC at our centre between 2001 and 2016. Only patients with follow-up data of more than 5 years were included in the study. We evaluated range of motion, grip strength, Mayo Modified Wrist Score (MMWS) and Quick Disabilities of Arm, Shoulder and Hand (Quick-DASH). Radiographic analyses were performed to assess the presence of radiocarpal osteoarthritis and the space between the radius and capitate. Results: Thirteen patients were included, with an average follow-up of 78.07 months (6.5 years). The MMWS was 65 points (four excellent and good, four fair and five poor results) and the Quick-DASH score was 30 points. X-ray analysis reported only 15.3% of patients with radiocarpal arthrosis and an average radio-capitate joint space of 1.92 mm. Conclusions: The outcomes of PRC in the management of PLI are comparable to the results reported in literature for conventional ORIF. PRC is a simpler procedure that minimises the need for re-intervention. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Sacha Tomczak
- Plastic and Reconstructive Surgery Department, Marseille, France
- Hand and Limbs Reconstructive Surgery Department, Marseille, France
| | - Maxime Abellan Lopez
- Plastic and Reconstructive Surgery Department, Marseille, France
- Hand and Limbs Reconstructive Surgery Department, Marseille, France
| | - Charlotte Jaloux
- Hand and Limbs Reconstructive Surgery Department, Marseille, France
| | - Regis Legre
- Hand and Limbs Reconstructive Surgery Department, Marseille, France
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Fisher ND, Bi AS, De Tolla JE. Perilunate Dislocations: Current Treatment Options. JBJS Rev 2022; 10:01874474-202209000-00003. [PMID: 36413343 DOI: 10.2106/jbjs.rvw.22.00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
➢ Approximately 25% of all patients who sustain perilunate dislocations present in a delayed fashion. ➢ While management of acute injuries is relatively well-described, treatment of chronic injuries can be complex and there is a paucity of scientific evidence to guide management. ➢ Treatment options include open reduction internal fixation, proximal row carpectomy, scaphoid or lunate excision with or without arthrodesis, and total wrist arthrodesis, although indications vary based on chronicity of injury and patient factors. ➢ The purpose of this article was to determine the quality of evidence supporting surgical options for the treatment of these injuries.
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Garçon C, Degeorge B, Coulet B, Lazerges C, Chammas M. Perilunate dislocation and fracture dislocation of the wrist: Outcomes and long-term prognostic factors. Orthop Traumatol Surg Res 2022; 108:103332. [PMID: 35609818 DOI: 10.1016/j.otsr.2022.103332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Perilunate dislocations and fracture-dislocations are severe injuries that often have serious functional sequelae. Our goal was to evaluate the long-term clinical and radiological results of these perilunate injuries, and to look for prognostic factors of a poor clinical outcome. HYPOTHESIS All patients who suffered perilunate injuries in their wrist have functional sequelae and long-term radiographic changes despite optimal treatment with anatomical surgical reduction. MATERIALS AND METHODS We did a single-center, retrospective study of 32 patients who had either an isolated perilunate dislocation (n=7) or fracture-dislocation (n=25) in their wrist. Pain, range of motion, strength and functional scores (MWS, PRWE, QuickDASH) were evaluated. Radiographs were analyzed to look for signs of osteoarthritis or carpal instability. RESULTS The mean follow-up time was 9.9years (3.5-24). The wrist joint had a mean flexion-extension of 86° (0-140), radioulnar deviation of 38° (0-65) and pronosupination of 153° (120-180). The mean grip strength was 35kg (5-56). The mean MWS, PRWE and QuickDASH scores were 65/100, 32/100 and 29/100, respectively. At the final assessment, 23 patients (79%) had radiographic signs of osteoarthritis while 5 patients (16%) had residual carpal instability. Three patients subsequently underwent palliative treatment. Opening the carpal tunnel and the magnitude of the lunate's displacement are significant predictors of a poor long-term functional outcome (p<0.05). Older age at the time of injury was a predictor for the development of osteoarthritis. DISCUSSION Despite optimal treatment, perilunate dislocations and fracture-dislocations at the wrist cause functional sequelae such as pain, stiffness, strength deficit and posttraumatic arthritis in nearly 80% of patients. The functional outcomes are determined by the amount of lunate displacement (stage) and the patient's age. We do not recommend opening the carpal tunnel, even when signs of median nerve compression are present; reducing the dislocation helps to relieve the neurological symptoms. LEVEL OF EVIDENCE IV; retrospective observational study.
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Affiliation(s)
- Charline Garçon
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
| | - Benjamin Degeorge
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Bertrand Coulet
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Cyril Lazerges
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Michel Chammas
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, 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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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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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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Çolak İ, Bulut G, Bekler Hİ, Çeçen GS, Gülabi D. Mid-term clinical and radiographic outcomes of perilunate injuries treated with open reduction and internal fixation. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:57-61. [PMID: 33650513 DOI: 10.5152/j.aott.2021.19246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to present the mid-term clinical and radiographic outcomes of patients with perilunate injuries treated with open reduction and internal fixation (ORIF). METHODS Patients who underwent ORIF due to perilunate injuries from 2004 to 2015 were retrospectively reviewed. Surgery was mostly performed using a standard dorsal approach. Each injury was graded as per Mayfield staging. At the final follow-up, pain intensity was evaluated using a 10-cm visual analog scale (VAS). Wrist and elbow range of motion, handgrip and pinch strength, Modified Mayo Wrist Scores, and the disabilities of the arm, shoulder, and hand (DASH) scores were measured. On plain radiographic examination, the scapholunate (SL) angle, SL interval, carpal height, and continuity of Gilula arcs were evaluated. The presence of arthritis was also assessed using the Herzberg classification. RESULTS In total, 26 male patients (27 wrists) who met the inclusion criteria were included in the study. The mean age was 40 years (range: 20-58); the mean follow-up was 45 months (range: 16-96). Most of the injuries were fracture-dislocations (n=20; 71.4%). According to Mayfield staging, 7 wrists were grade 3, and 20 wrists were grade 4. According to Herzberg staging, 11 (40.7%) patients were stage 2a. The mean VAS was 2.3 (range: 0-5) at rest and 3.3 (range: 0-7) during activity. The mean wrist flexion and extension were 50° (range: 21-80°; 73.5% of the unaffected side) and 45.1° (range: 20-74°; 70.9% of the unaffected side), respectively. The mean radial and ulnar deviation were 14.6° (range: 6-25°; 63.6% of the unaffected side) and 22.3° (range: 5-40°; 64.7% of the unaffected side), respectively. Grip and pinch strength were 57.6 kg (range: 15-106; 65.5% of the unaffected side) and 18.6 kg (range: 8-28; 78.2% of the unaffected side), respectively. The mean Mayo score was 63.3 (range: 20-90), and the DASH score was 24.1±25.2. The mean SL angle was 61.6° (range: 40-83). There was 1 wrist with a pathological SL interval, 11 wrists with dorsal intercalated segmental instability, and 3 wrists with fractures of the Gilula arcs. The mean carpal height was within the normal range. CONCLUSION In the treatment of perilunate injuries, satisfactory clinical and radiographic outcomes can be expected from ORIF at mid-term follow-up. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- İlker Çolak
- Department of Orthopaedics and Traumatology, Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Güven Bulut
- Department of Orthopaedics and Traumatology, Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Halil İbrahim Bekler
- Clinic of Orthopaedics and Traumatology, VM Medical Park Pendik Hospital, İstanbul, Turkey
| | - Gültekin Sıtkı Çeçen
- Department of Orthopaedics and Traumatology, Bahcesehir University, School of Medicine, İstanbul, Turkey
| | - Deniz Gülabi
- Clinic of Orthopaedics and Traumatology, VM Medical Park Pendik Hospital, İstanbul, Turkey
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Jerome TJ, Prabu GR. Proximal row carpectomy for complex perilunate fracture dislocations with migration of proximal scaphoid bone into the forearm. HAND SURGERY & REHABILITATION 2020; 40:299-304. [PMID: 33309983 DOI: 10.1016/j.hansur.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022]
Abstract
Complex perilunate dislocations include scaphoid, triquetrum, radial styloid fractures, and associated ligamentous injuries. The purpose of the study is to assess the role of proximal row carpectomy (PRC) in such complex injuries involving the proximal scaphoid migration and analyze the outcome. We operated on eighteen patients with complex perilunate dislocations and extreme proximal migration of proximal scaphoid by PRC between 2012 and 2018. We analyzed the postoperative radiographs, VAS pain score, range of motion, return to work, Quick DASH and Mayo wrist scores and assessed the overall functional outcome. The average follow-up was 46 months. The mean range of wrist flexion was 65%, extension 70 %, pronation 88%, supination 90%, and grip strength 70% of the opposite side. The median VAS pain score was 0.1 (range, 0-3). Median Quick DASH score was 4.4 (range, 3.3-6.7), and Mayo wrist score 70 (range, 65-75). The age, gender, side of injury, dominant hand, fracture displacement or type, osteochondral fracture of the capitate head, and treatment delay had no significant impact on the functional outcome. The presence of degenerative changes had no significant association with age, grip strength, range of movements, pain, and outcome scores. All patients had good subjective satisfaction with the surgery and functional outcome. PRC is a reliable option for complex perilunate fracture-dislocations with extended proximal migration of the scaphoid proximal pole. The degenerative changes after PRC may progress with time, mostly when done for young patients. Outcomes of salvage procedure in the long-term follow-up need to be taken into account when counselling patients on the treatment of these injuries.
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Affiliation(s)
- T J Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamil Nadu 620017, India.
| | - G R Prabu
- Department of Orthopedics, KAPV Medical College Hospital, Periyamilaguparai, Colletor's Office Road, Trichy, Tamil Nadu 620001, India
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Long-term radiological changes and functional outcomes after proximal row carpectomy: Retrospective study with 3 years' minimum follow-up. Orthop Traumatol Surg Res 2020; 106:1589-1595. [PMID: 33289656 DOI: 10.1016/j.otsr.2020.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the radiological changes and determine the clinical and functional outcomes of proximal row carpectomy (PRC) over the long term. HYPOTHESIS Radiological changes after PRC occur in every patient while the clinical and functional outcomes remain stable over time. METHODS This was a retrospective single-center study of patients who underwent PRC between January 2004 and December 2014. A clinical assessment (range of motion, grip strength), functional assessment (Mayo Wrist score and QuickDASH) and radiographic assessment (radiocapitate osteoarthritis, radiocapitate congruency) was done in every patient at the longest follow-up. RESULTS Thirty-one patients were reviewed with a mean follow-up of 97.9 months. The indications for PRC were SLAC (n=10), SNAC (n=5), Kienböck disease (n=9) and other conditions (n=7). The radiocapitate index, which is the radius of curvature of the tip of the capitate divided by the mean radius of curvature of the lunate fossa, went from 0.68 immediately postoperative to 0.74 at the final assessment (p=0.035). The mean flexion/extension arc was 93°. The mean grip strength was 25 kg. The mean QuickDASH was 29 and the mean Mayo Wrist score was 69. Fifteen patients had radiocapitate osteoarthritis. Seven patients (22%) required revision surgery for wrist fusion after a mean of 18.6 months. CONCLUSION Radiological adaptation in the radiocapitate joint after PRC was found in this study. PRC is a reliable solution and yields stable outcomes over time for treating radiocarpal osteoarthritis, except in young adults and manual laborers who had a notable early revision rate. LEVEL OF EVIDENCE IV - retrospective study.
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Wu K, Athwal GS, Ross D. Total Scapholunate Extrusion Into the Forearm in a Transscaphoid, Transcapitate Perilunate Fracture Dislocation: A Case Report. JBJS Case Connect 2020; 10:e1900534. [PMID: 32910567 DOI: 10.2106/jbjs.cc.19.00534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 50-year-old woman involved in a motorcycle accident sustained a transscaphoid transcapitate perilunate fracture dislocation with complete extrusion of the proximal scaphoid pole and lunate as a unit into the forearm. The patient underwent urgent open reduction and internal fixation (ORIF) with screw fixation of the capitate and Kirschner wire fixation of the scaphoid, midcarpal joint, and lunotriquetral intervals. At 1-year postoperatively, radiographs confirm healing of capitate and scaphoid fractures, with no signs of avascular necrosis of the lunate. CONCLUSION Despite a complex fracture-dislocation pattern, treatment with ORIF can successfully lead to scaphoid and capitate union and lunate revascularization.
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Affiliation(s)
- Kitty Wu
- 1Department of Plastic and Reconstructive Surgery, Western University, London, Ontario Canada 2Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care Centre, London, Ontario, Canada
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Yoon J, Esposito SB, Marschall MD, Greenberg MR, Nguyen MC. Complete Anterior Scaphoid Expulsion in Transscaphoid-Lunate Dislocation in an Adult Male After Fall. J Emerg Med 2020; 58:336-338. [PMID: 32001121 DOI: 10.1016/j.jemermed.2019.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer Yoon
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine, Allentown, Pennsylvania
| | - Samantha B Esposito
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine, Allentown, Pennsylvania
| | - Matthew D Marschall
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine, Allentown, Pennsylvania
| | - Michael C Nguyen
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of Medicine, Allentown, Pennsylvania
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Goodman AD, Harris AP, Gil JA, Park J, Raducha J, Got CJ. Evaluation, Management, and Outcomes of Lunate and Perilunate Dislocations. Orthopedics 2019; 42:e1-e6. [PMID: 30403823 DOI: 10.3928/01477447-20181102-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/07/2018] [Indexed: 02/03/2023]
Abstract
Lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Prompt recognition and treatment is necessary to prevent adverse sequelae, including median nerve dysfunction, carpal instability, posttraumatic arthritis, reduced functionality, and avascular necrosis. In patients who are surgical candidates, operative intervention is warranted to restore carpal kinematics and provide optimal outcomes. [Orthopedics. 2019; 42(1):e1-e6.].
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Case Report of an Acute Complex Perilunate Fracture Dislocation Treated with a Three-Corner Fusion. Case Rep Orthop 2018; 2018:8397638. [PMID: 29951332 PMCID: PMC5989276 DOI: 10.1155/2018/8397638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
Abstract
Perilunate fracture dislocations are a rare but devastating injury, which is often missed on initial presentation leading to significant delays in treatment. With the delay in treatment and a high energy mechanism of injury, patients are at increased risk of developing complex regional pain syndrome following trauma. In this report, we review the case of a 57-year-old left-hand dominant female who presented to a clinic with a five-and-a-half-week-old transtriquetral, perilunate fracture dislocation with comminution of the scaphoid facet. Due to the increased likelihood of a secondary procedure and low probability of a satisfactory outcome with open reduction internal fixation secondary to the loss of the scaphoid articulation, a salvage procedure was deemed her best option. To our knowledge, this is the first case reported in the literature in which a scaphoidectomy, triquetromy, and midcarpal fusion (three-corner fusion) was performed in the acute setting for a perilunate fracture dislocation.
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Transradial Styloid Perilunate Dislocation: A Rare Case. Trauma Mon 2017. [DOI: 10.5812/traumamon.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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