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Pappa E, Argyrou C, Tetsios G, Ampadiotaki MM, Syngouna S, Kanellos P, Fandridis E. Surgical management and functional outcomes of perilunate dislocations and fracture dislocations through the dorsal approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03999-3. [PMID: 38761199 DOI: 10.1007/s00590-024-03999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. PURPOSE The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. PATIENTS AND METHODS In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. RESULTS The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. CONCLUSION In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. LEVEL OF EVIDENCE IV Retrospective case series study.
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Affiliation(s)
- Eleni Pappa
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece.
| | - Chrysoula Argyrou
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | - George Tetsios
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | | | - Sophia Syngouna
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | - Panagiotis Kanellos
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | - Emmanouil Fandridis
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
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Carroll TJ, Botros M, Lander R, Moody S, Reitenbach ML, Wilbur D. Predicting Acute Median Neuropathy in Perilunate Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:58-61. [PMID: 38313628 PMCID: PMC10837300 DOI: 10.1016/j.jhsg.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Perilunate fracture dislocation (PLFD) injuries are associated with the development of acute carpal tunnel syndrome (CTS). The purpose of our study was to identify the factors that increase the likelihood of developing CTS in patients with PLFD. Additionally, we attempted to classify patients who did not initially undergo carpal tunnel release (CTR) at the time of injury but eventually underwent CTR within the follow-up period. Methods Patients presenting to a level-1 trauma center with isolated PLFDs (Mayfield III-IV) were retrospectively identified by using CPT and ICD-10 codes. Polytraumatized patients, those with a history of previous wrist trauma, or those with previous carpal tunnel symptoms or surgery were excluded. Outcomes of interest included the development of acute CTS, pre- and post-reduction changes in CTS symptoms, and associated hand and wrist fractures. Chi-square tests, Kruskal-Wallis tests, and multivariate logistic regression were used to examine the predictors of developing CTS after a PLFD. Results In total, 43 patients were included in the final cohort, with a mean age of 44 years, of which 77% were men. The most common fracture of the carpus included scaphoid fractures (9/43, 21%). The average time from presentation to reduction was 636 minutes. Acute CTS symptoms before reduction were present in 26% of the patients and increased post-reduction to 28%. No difference exists between the time to sedation and the presence of acute carpal tunnel symptoms (P >.05). During initial surgical intervention, 79% underwent CTR (27/34). Of the seven patients who did not initially undergo a CTR, 57% (4/7) required a CTR within the follow-up period. Conclusion Reduction of PLFDs did not significantly improve the number of patients with acute CTS. More than 50% of the patients who did not undergo a CTR at the initial surgery required a CTR within the follow-up period. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Thomas John Carroll
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Mina Botros
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Richard Lander
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Sophia Moody
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Megan L. Reitenbach
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Danielle Wilbur
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
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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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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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Alshehri D, Mousa A, Al Ahmadi B. Trans-scaphoid Lunate Dislocation Rare Injury: A Case Report. Cureus 2023; 15:e44072. [PMID: 37750144 PMCID: PMC10517882 DOI: 10.7759/cureus.44072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/27/2023] Open
Abstract
Lunate dislocations are complex and uncommon wrist injuries, often resulting from high-energy trauma like road traffic accidents, falls, and industrial mishaps. Timely diagnosis and appropriate surgical management are critical to achieving favorable outcomes and minimizing long-term disability. Here, we present a case of a 22-year-old male who sustained a trans-scaphoid lunate fracture dislocation due to a motorcycle accident. Prompt wrist x-ray evaluation and subsequent surgical interventions led to the successful restoration of wrist function and stability. This case report highlights the importance of early recognition and discusses the accurate diagnosis and timely management of lunate fracture dislocations to avoid long-term complications and disability.
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Affiliation(s)
- Dhafer Alshehri
- Orthopaedic Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | | | - Basim Al Ahmadi
- Orthopaedic Surgery, King Fahad General Hospital, Jeddah, SAU
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Yi Z, Qi W, Chen S, Zhang Y, Liu B. A Novel Mini-Invasive Technique of Arthroscopic-Assisted Reduction and Robot-Assisted Fixation for Trans-Scaphoid Perilunate Fracture Dislocations. Orthop Surg 2023; 15:1203-1209. [PMID: 36864552 PMCID: PMC10102287 DOI: 10.1111/os.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Perilunate injuries are rare but devastating carpal injuries. The treatment of perilunate injuries remains challenging and contentious. This study aims to describe a novel mini-invasive surgical technique of arthroscopic-assisted reduction and robot-assisted fixation for the treatment of trans-scaphoid perilunate fracture dislocations (PLFDs). METHODS We retrospectively reviewed patients with PLFDs after surgical treatment from February 2021 to March 2021. The patients underwent arthroscopic-assisted precise reduction and robot-assisted headless screw fixation. Times of guide wire placement were recorded intraoperatively. Periodic follow-up was performed until union of scaphoid fracture was confirmed. Range of motion of the wrist, grip strength, the Visual Analog Scale (VAS) score, the Mayo Wrist Score, the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE), and osteoarthritis were evaluated at the final follow-up. RESULTS Two male patients presenting with PLFDs with an average age of 24.5 years old (32 and 17 years) were included in this study. Intraoperatively, anatomic reduction of the scaphoid fracture was achieved under arthroscopic guidance. A robotic-assisted single-attempt guidewire insertion was performed for scaphoid fracture and lunotriquetral interval. The CT scans at 8 and 12 weeks showed the union of the scaphoid fracture. At final mean follow-up of 13.5 months, the extension, radial-ulnar deviation, and pronation-supination were consistent with the contralateral side in both patients. One patient experienced mild limited range of motion with the flexion 46° of the injured wrist compared with 81°of the contralateral wrist. The VAS score was 0 and 2. The grip strength was 32 and 26 kg compared with 24 and 42 kg of the contralateral wrist. The PRWE score was 13 and 10 and the QuickDASH score was 2 and 7. The Mayo Wrist Score was 100 and 65. No sign of osteoarthritis was found at the last follow-up. CONCLUSIONS Arthroscopic-assisted reduction and robot-assisted fixation is a viable and promising alternative for the treatment of perilunate fracture dislocations. This technique allows precise reduction and accurate placement of the K-wires/screws into the carpal bones through the optimal biomechanical paths.
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Affiliation(s)
- Zhe Yi
- Department of Hand Surgery, Beijing JiShuiTan Hospital, The Fourth Clinical College of Peking University, Beijing, China
| | - Weiya Qi
- Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou, China
| | - Shanlin Chen
- Department of Hand Surgery, Beijing JiShuiTan Hospital, The Fourth Clinical College of Peking University, Beijing, China
| | - Yuhao Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo Liu
- Department of Hand Surgery, Beijing JiShuiTan Hospital, The Fourth Clinical College of Peking University, Beijing, China
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