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Schriever T, Swärd E, Wilcke M. Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial. J Hand Surg Eur Vol 2024; 49:601-607. [PMID: 37903310 DOI: 10.1177/17531934231209872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
This pragmatic randomized controlled trial compared lunocapitate fusion (LCF) and four-corner fusion (4CF) for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) in 64 patients. The primary outcome was change in grip strength from preoperative to 1 year postoperatively. The secondary outcomes were Disability of the Hand, Arm, and Shoulder score, Patient Rated Wrist Evaluation score, EuroQol-5D-3L, range of motion, key pinch strength and complications 12 months postoperatively. Grip strength improved only to a small extent and there was no difference between the groups. No differences were found in the secondary outcomes. In conclusion, LCF is not inferior to 4CF regarding strength, range of motion or patient-reported outcome measures.Level of evidence: I.
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Affiliation(s)
- Thorsten Schriever
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Elin Swärd
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
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2
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de Villeneuve Bargemon JB, Dubian R, Witters M, Jaloux C. Scaphoid proximal pole ejection in perilunate injury: a case report and pathophysiological hypothesis. Hand Surg Rehabil 2024; 43:101631. [PMID: 38185366 DOI: 10.1016/j.hansur.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Abstract
Isolated ejection of the scaphoid proximal pole in perilunate injuries is rare, with only 4 reports in the literature, and does not correspond to the biomechanical situations in the Herzberg or Mayfield classifications. Bone ejection incurs a risk of avascular necrosis despite good osteosynthesis, notably because of precarious vascularization. We present a case of scaphoid proximal pole ejection and a theoretical hypothesis of the biomechanics of this injury. LEVEL OF EVIDENCE: 4.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, 99 Avenue Saint Roch, 83100 Toulon, France; Department of Hand Surgery, Plastic and Reconstructive Surgery of the Limbs - La Timone University Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Rémy Dubian
- Department of Hand Surgery, Plastic and Reconstructive Surgery of the Limbs - La Timone University Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marie Witters
- Department of Hand Surgery, Plastic and Reconstructive Surgery of the Limbs - La Timone University Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Department of Hand Surgery, Plastic and Reconstructive Surgery of the Limbs - La Timone University Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
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3
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Helfter L, Forli A, Philippides A, Bouyer M, Corcella D. Ligamentoplasty in scapholunate instability: short-term results of the "all dorsal scapholunate repair" technique. Eur J Orthop Surg Traumatol 2024; 34:1037-1044. [PMID: 37897667 DOI: 10.1007/s00590-023-03765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
Injury to the scapholunate complex is the cause of scapholunate instability which can lead to radiocarpal and medio-carpal osteoarthritis. Several ligamentoplasty techniques have been reported for the treatment of chronic scapholunate instability before the osteoarthritis stage. The objective of this study was to assess the short-term results of an "all dorsal scapholunate repair" ligamentoplasty. We report the clinical, radiological and functional results of a retrospective study including 21 patients, operated between June 2019 and December 2020 for a stage 3 or 4 scapholunate instability according to the Garcia Elias classification. With a follow-up of 14.2 months, the pain was 0.1/10 according to the VAS at rest and 4/10 during exercise. Wrist strength was measured at 65% of the opposite side. The flexion-extension range of motion was 105°. Radiologically, there was a reduction of the diastasis and scapholunate angle. Osteolysis areas around the anchors were described in 47% of patients. The mean QuickDASH was 29.2/100, PRWE 24/100 and Mayo wrist score 67.8/100. Eighty-one percent of patients were satisfied. Seventeen patients had returned to work 5.2 months postoperatively. In the case of work-related injury, the functional scores were poorer, with a delayed return to work. This technique provides encouraging results in the short term. Most patients were improved compared to preoperative state. The work-related injury appears to be a poor prognostic factor. A longer-term study is imperative to confirm the maintenance over time of the correction of carpal malalignment and the evolution of the osteolysis areas.Level of evidence: Level IV Retrospective study.
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Affiliation(s)
- Laura Helfter
- Service de Chirurgie de la Main, Réparatrice des Membres et Microchirurgie, CHU de Grenoble, Boulevard de la Chantourne, 38000, Grenoble, France.
| | - Alexandra Forli
- Service de Chirurgie de la Main, Réparatrice des Membres et Microchirurgie, CHU de Grenoble, Boulevard de la Chantourne, 38000, Grenoble, France
| | - Antoine Philippides
- Département de Neurosciences Fondamentales, Université de Genève, 1 Rue Michel Servet, 1211, Geneva, Switzerland
| | - Michael Bouyer
- Centre Orthopédique Alpes Annecy, Clinique Générale, 4 Chemin de la Tour la Reine, 74000, Annecy, France
| | - Denis Corcella
- Service de Chirurgie de la Main, Réparatrice des Membres et Microchirurgie, CHU de Grenoble, Boulevard de la Chantourne, 38000, Grenoble, France
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4
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Prénaud C, Merlini L, de Villeneuve Bargemon JB, Gregory T, Dacheux C. Correlation between dorsal capsulo-scapholunate septum (DCSS) lesion and predynamic scapholunate instability. Hand Surg Rehabil 2024; 43:101609. [PMID: 37879459 DOI: 10.1016/j.hansur.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Scapholunate instability is the most common ligament injury of the wrist. In case of predynamic instability, diagnosis can be difficult, even under arthroscopy. Scapholunate instability is not the result of an isolated injury to the scapholunate interosseous ligament. Scapholunate stability is dependent not only on the scapholunate ligament, but on a complex that is comprising intrinsic and extrinsic ligaments. The dorsal capsule-scapholunate septum (DCSS) is one of the secondary stabilizers of the scapholunate complex. The objective of the present study was to investigate the correlation between DCSS lesion and predynamic scapholunate instability. METHOD A prospective multicenter study included patients who underwent wrist arthroscopy for traumatic wrist. Arthroscopic DCSS lesion stage and instability according to European Wrist Arthroscopy Society stage were assessed. RESULTS Twenty-seven subjects were included. We found a significant correlation between pathological DCSS and predynamic scapholunate instability and a correlation between DCSS lesion severity and instability level. CONCLUSION Isolated DCSS lesion should be considered a predictive factor for predynamic instability.
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Affiliation(s)
- Clément Prénaud
- Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France.
| | | | | | - Thomas Gregory
- Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Charles Dacheux
- Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
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5
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Yeager KC, Parker KM, Morrell NT. A Case for Acute Proximal Row Carpectomy for Perilunate Injuries. Iowa Orthop J 2023; 43:14-19. [PMID: 38213853 PMCID: PMC10777708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Perilunate injuries are complex injuries typically arising from high-energy injuries to the wrist. Standard treatment involves open reduction and internal fixation with ligamentous reconstruction; however, outcomes are fraught with complications including pain, stiffness, and arthrosis. Several case reports have demonstrated the role of proximal row carpectomy as a salvage procedure for complex carpal trauma in the setting of significant cartilage injury or bone loss. The authors believe that proximal row carpectomy may be an appropriate acute treatment in certain patient populations, with functional results similar to those obtained with ligamentous reconstruction. Methods A retrospective review of two cases with perilunate dislocations managed with primary proximal row carpectomy are presented. Results At greater than 1-year follow-up, both patients had stable radiocarpal alignment. Quick-DASH scores were 22.7 and 27.3. Conclusion Primary proximal row carpectomy is a treatment option in the acute setting for perilunate injuries in elderly, lower-demand patients. Functional results are similar to those obtained with ligamentous reconstruction, with a shorter recovery period. Level of Evidence: IV.
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Affiliation(s)
- Kathryn C. Yeager
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Kate M. Parker
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Nathan T. Morrell
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Hospital, Albuquerque, New Mexico, USA
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6
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Wessel LE, Wolfe SW. Scapholunate Instability: Diagnosis and Management - Anatomy, Kinematics, and Clinical Assessment - Part I. J Hand Surg Am 2023; 48:1139-1149. [PMID: 37452815 DOI: 10.1016/j.jhsa.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/19/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023]
Abstract
Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA.
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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7
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Wozniak S, Paulsen F. Introducing the Foveola lunata, an anatomical landmark of the wrist. Ann Anat 2023; 250:152163. [PMID: 37778712 DOI: 10.1016/j.aanat.2023.152163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
The lunate foveola is often the starting point of a cystic swelling called a "ganglion". To make the anatomy of this region more relevant to the needs of clinicians and more accessible to students, we propose to introduce the term lunate foveola (Foveola lunata) on the dorsal side of the wrist just distal to the os lunatum. The easily located foveola will help in the examination of the wrist to more easily understand the anatomy of the wrist and facilitate the examination of patients with wrist injuries when an injury to the lunate (Os lunatum) is suspected.
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Affiliation(s)
- Slawomir Wozniak
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Chalubinskiego 6a, 50-368 Wroclaw, Poland.
| | - Friedrich Paulsen
- Friedrich Alexander University Erlangen-Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Universitätsstr. 19, 91054 Erlangen, Germany
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Starr BW, Chung KC. InternalBrace for Intercarpal Ligament Reconstruction. Hand Clin 2023; 39:379-388. [PMID: 37453765 DOI: 10.1016/j.hcl.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Scapholunate and lunotriquetral instability are common causes of chronic, debilitating wrist pain and functional impairment. In the setting of subacute or chronic injuries with predynamic or dynamic instability, the ideal surgical approach remains unclear. In January 2020 the authors started enrolling patients with predynamic and dynamic instability in an Institutional Review Board-approved prospective study, aimed at meticulously studying outcomes using the all-dorsal InternalBrace reconstruction technique. The all-dorsal technique described herein is straightforward, efficient, and easy to learn, with early outcomes equivalent or superior to those of other techniques.
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Affiliation(s)
- Brian W Starr
- Section of Plastic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2020, Cincinnati, OH 45229, USA; University of Cincinnati College of Medicine, 3230 Eden Avenue Cincinnati, OH 45267, USA.
| | - Kevin C Chung
- Section of Plastic Surgery, The University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, USA
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10
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Li J, Zhao G, Zhang W. Comminuted lunate fracture combined with distal radius fracture and scaphoid fracture: A case report. Medicine (Baltimore) 2023; 102:e34393. [PMID: 37478227 PMCID: PMC10662819 DOI: 10.1097/md.0000000000034393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023] Open
Abstract
RATIONALE Incidence of lunate fractures is very low, less than 1% of all fractures. Lunate fractures generally come from high-energy injuries, often combined with other wrist fractures. Simple lunate fractures can be fixed with screws or Kirschner wires. However, Comminuted lunate fractures are difficult to reduce and fixe by conventional methods. PATIENT CONCERNS Here we report a 42-year-old male construction worker who was crushed by an excavator bucket and presented with comminuted lunate fracture combined with distal radius fracture and scaphoid fracture. DIAGNOSES Comminuted lunate fracture, distal radius fracture, and scaphoid fracture. INTERVENTIONS The posterior approach was used to reconstruct the radial lunate bone with polymethylmethacrylate cement, and cannulated screws were used to fix the scaphoid and distal radius fractures. OUTCOMES At the 3rd month after surgery, the movement of the right wrist joint improved. At the sixth month after surgery, the patient returned to the building site and began working at the same intensity as before the injury. LESSONS Although the incidence of comminuted lunate fractures is very low, they occur sometimes. For comminuted lunate fractures, early identification and intervention can preserve most of the function of the wrist joint.
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Affiliation(s)
- Jun Li
- Xi’an People’s Hospital, Shannxi, China
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11
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Imada AO, Welch K, Mlady G, Moneim MSA. The tangential view described by Moneim to demonstrate scapholunate dissociation: an update. Eur J Orthop Surg Traumatol 2023; 33:2005-2010. [PMID: 36112227 PMCID: PMC10276066 DOI: 10.1007/s00590-022-03391-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Scapholunate dissociation is a common and significant injury to the wrist. Radiographs are important in the diagnosis of this injury and in the planning of treatment. The tangential radiograph view was described almost 40 years ago as a method for accurately measuring scapholunate gaps. The hand is positioned on a 20° foam rubber block and the thumb on the cassette, which positions the scaphoid and lunate articular surfaces parallel, without patient discomfort or effort. The goal of this study was to review this method with more recent data and in a larger group of patients. METHODS Radiographs of 31 patients who had scapholunate interosseous ligament tears and surgical repair over a 9 year period were retrospectively evaluated. Each of the four authors independently measured scapholunate gaps for posteroanterior and tangential views. RESULTS The tangential view gaps were significantly greater than the posteroanterior gaps overall. Similar results were found for borderline cases where the posteroanterior gap was less than 3 mm. Every tangential view gap measurement was greater than its respective posteroanterior gap with good inter-rater reliability. CONCLUSION The tangential view is a reliable radiographic method to identify scapholunate gaps. It should be obtained when there is clinical concern for scapholunate dissociation, especially in patients with borderline posteroanterior gaps.
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Affiliation(s)
- Allicia O Imada
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, 87121, USA.
| | - Kathryn Welch
- Department of Radiology, The University of New Mexico, Albuquerque, NM, USA
| | - Gary Mlady
- Department of Radiology, The University of New Mexico, Albuquerque, NM, USA
| | - Moheb S A Moneim
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, 87121, USA
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12
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Jasqui-Remba S, Jasqui-Bucay A, Portman-Santos D. Anterior dislocation of the lunate due to a high-energy trauma. Acta Ortop Mex 2023; 37:106-108. [PMID: 37871934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Semilunate and perilunate dislocation is an injury that mostly occurs when the subject is exposed to a high-energy trauma. Considered severe, it compromises the stability and function of the wrist. The case presented is that of a 50-year-old male patient who after having a motorcycle accident arrived at the ER with neurovascular affectation, swelling, deformity and a considerable decrease of the wrist joint movement. He was also referring severe pain. A Henry (Volar) intervention was done with the help of external fixation of the lunate, followed by K-wire fixation, once a prior closed reduction was unsuccessfully attempted. The scaphoid was connected to the semilunate, and then the latter with the capitate. Ligament reconstruction followed, and stability was clinically confirmed with an X-ray. Although improvement of symptomatology was observed during the follow-up analysis, motion of the wrist remained limited. Even with the best treatment, in terms of functionality, this type of injury presents a poor prognosis.
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Affiliation(s)
- S Jasqui-Remba
- American British Cowdray Medical Center, IAP. Mexico City, Mexico
| | - A Jasqui-Bucay
- American British Cowdray Medical Center, IAP. Mexico City, Mexico
| | - D Portman-Santos
- American British Cowdray Medical Center, IAP. Mexico City, Mexico
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13
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Lui TH, Slocum AMY. Scaphoid Shift Test in Scapholunate Ligament Injury. N Engl J Med 2022; 387:e46. [PMID: 36317762 DOI: 10.1056/nejmicm2202238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Tun H Lui
- North District Hospital, Hong Kong, China
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Ishizaki A, Omokawa S, Hasegawa H, Nagashima M, Shimizu T, Kawamura K, Tanaka Y. Simultaneous Bilateral Chronic Volar Lunate Dislocation: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00052. [PMID: 35703161 DOI: 10.2106/jbjs.cc.22.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 24-year-old professional judo competitor suffered injuries to both the wrists when he fell on his back while lifting a 90-kg barbell in the bilateral dorsiflexed wrist position. Simultaneous bilateral volar lunate dislocation had been missed for a year. The degenerated lunates were simultaneously removed using a palmar approach. At 12 months postoperatively, the patient returned to judo competitions without pain. Radiography showed no progression of the intercarpal alignment abnormality. CONCLUSION Simultaneous bilateral chronic volar lunate dislocation is extremely rare. Long-term follow-up is necessary to check for carpal alignment.
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Affiliation(s)
- Ayumu Ishizaki
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hideo Hasegawa
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Mitsuyuki Nagashima
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takamasa Shimizu
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kenji Kawamura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
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16
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Raaijmaakers AMR, van de Kimmenade RJLL, Wolvius RJ. [A painful, swollen wrist after a fall from a bicycle]. Ned Tijdschr Geneeskd 2021; 165:D5500. [PMID: 33793121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This case concerns a male with a painful and swollen wrist after a fall from a bicycle. Physical examination of the wrist showed medial nerve compression. Radiographic analyses showed a lunate dislocation. A lunate dislocation is an often missed diagnosis, resulting in a delay in treatment and worse outcome.
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17
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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 Orthop Traumatol Turc 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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Abstract
RATIONALE Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.
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Affiliation(s)
- Yuji Tomori
- Departments of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
- Departments of Orthopaedic Surgery, Ukima Central Hospital
| | - Mitsuhiko Nanno
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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19
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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: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [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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20
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Abstract
RATIONALE Lunate fractures are very rare, accounting for only 0.5% to 6.5% of all carpal fractures. They are mostly caused by high-energy trauma and commonly occur with fractures and dislocations of other carpal bones. It is rarely combined with Colles' fracture and the underlying pathogenesis and prognostic significance still remain controversial. PATIENT CONCERNS Here we report a case of a fresh lunate fracture combined with Colles' fracture, without dislocations of other carpal bones caused by a low-energy fall injury. DIAGNOSES Lunate fracture, Colles' fracture. INTERVENTIONS This patient received closed reduction and internal fixation (CRIF) with K-wire. OUTCOMES The patient took follow up 1 year and the patient showed good function of the wrist joint LESSONS:: Lunate fractures have no high misdiagnosis rate. Patients suffering persistent wrist swelling after a trauma should be carefully examined and followed up to prevent severe secondary diseases and wrist joint dysfunction.
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Affiliation(s)
| | - Baoming Yuan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | | | | | | | - Dankai Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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21
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Affiliation(s)
- Philip Beak
- St George's University NHS Foundation Trust, London, UK
| | - Shamim Umarji
- St George's University NHS Foundation Trust, London, UK
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22
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Gillis JA, Higgins JP. Coronal Fracture of the Lunate in Advanced Kienböck Disease: Reestablishing Midcarpal Congruency to Enable Osteochondral Reconstruction: A Case Report. JBJS Case Connect 2018; 8:e37. [PMID: 29901478 DOI: 10.2106/jbjs.cc.17.00254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
CASE We describe a patient with Bain grade-2b Kienböck disease with a coronal fracture of the distal lunate articular surface with proximal structure collapse. To reestablish midcarpal congruity, we used a bone-anchored suture to repair the coronal split in the lunate in preparation for lunate preservation with osteochondral medial femoral trochlea (MFT) reconstruction. CONCLUSION In Bain grade-2b Kienböck disease, lunate reconstruction of both the proximal and distal joint surfaces can be performed. Successful reconstruction of the distal articular surface can be achieved using a bone-anchored FiberWire (Arthrex) suture technique. This can be employed in conjunction with an osteochondral MFT reconstruction of the proximal aspect of the lunate. Patients with this commonly encountered coronal fracture of the distal articular surface may be considered candidates for lunate reconstruction via this technique rather than conventional ablative procedures.
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Affiliation(s)
- Joshua A Gillis
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
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23
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Borgese M, Boutin RD, Bayne CO, Szabo RM, Chaudhari AJ. Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint. Skeletal Radiol 2017; 46:1729-1737. [PMID: 28828602 PMCID: PMC5710747 DOI: 10.1007/s00256-017-2747-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/30/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. MATERIALS AND METHODS We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). RESULTS AND CONCLUSION Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears.
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Affiliation(s)
- Marissa Borgese
- Department of Radiology, University of California - Davis, Sacramento, CA, 95817, USA
| | - Robert D Boutin
- Department of Radiology, University of California - Davis, Sacramento, CA, 95817, USA
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California - Davis, Sacramento, CA, 95817, USA
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California - Davis, Sacramento, CA, 95817, USA
| | - Abhijit J Chaudhari
- Department of Radiology, University of California - Davis, Sacramento, CA, 95817, USA.
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24
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Brown KV, Tsekes D, Gorgoni CG, Di Mascio L. The treatment of perilunate ligament injuries in multiply injured patients. Eur J Trauma Emerg Surg 2017; 45:73-81. [PMID: 29018873 DOI: 10.1007/s00068-017-0856-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Perilunate injuries are rare, severe injuries of the carpus. They can present as isolated injuries or in the poly-traumatised patient. This is the first documented series of these injuries treated in a Major Trauma Centre. The aims were to assess the management, treatment algorithm and outcomes, of perilunate injuries in our department, review whether concomitant polytrauma affected those outcomes and identify if delay to definitive treatment had a significant effect on overall outcome. METHODS Perilunate injuries admitted to the Royal London Hospital between Oct 2011 and March 2016 were identified. All definitive surgical procedures were performed by the senior author; hand therapists supervised patient rehabilitation. Outcomes were assessed by Mayo Wrist and QuickDASH scores. RESULTS We identified 23 perilunate injuries (22 patients). There was an associated nerve injury in 10 cases with other system injuries present in 12 cases. At final review, the mean carpal height ratio was 0.56, Mayo Wrist score was 81 and QuickDASH score was 16.4. There were no differences when comparing the outcomes of patients who had early against those with more delayed definite treatment or when comparing patients with isolated wrist injuries against polytrauma patients. CONCLUSION Satisfactory outcomes can be achieved, even in the presence of other injuries, if initial treatment is prompt and follows a clear management protocol. Prompt early reduction and neurological decompression followed by subsequent accurate definitive fixation leads to good outcomes. A delay of definitive fixation of up to 18 days does not appear to have a deleterious effect on outcome.
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Affiliation(s)
- K V Brown
- Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
| | - D Tsekes
- Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
- , 18 Chandos Court, London, N147AA, UK.
| | - C G Gorgoni
- Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
| | - L Di Mascio
- Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
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25
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Abstract
Acute lunate dislocations are unusual and devastating injuries to the wrist. They are very rare in adult wrist injuries but extremely rare in children. Only six cases of perilunate dislocations in children have been reported in the literature, and in addition to this, only a single case of a lunate dislocation in a child has been reported.Here, we report a case of a 10-year-old boy who presented with an acute lunate dislocation of the wrist, following trauma, a second of its kind.
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Affiliation(s)
- Shehzaad Aziz Khan
- Trauma and Orthopaedics, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
- Trauma and Orthopaedics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Menanta Van Velze
- Trauma and Orthopaedics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Andrew Pearse
- Trauma and Orthopaedics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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26
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Lee JM, Kim JK, Lee KB. Extreme proximal migration of dislocated lunate over carpal ligament - A case report. Acta Orthop Traumatol Turc 2017; 51:177-180. [PMID: 28017515 PMCID: PMC6197394 DOI: 10.1016/j.aott.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/25/2015] [Accepted: 02/06/2015] [Indexed: 12/03/2022]
Abstract
Dislocation of the lunate and proximal pole of the scaphoid with displacement of the fragments proximal to the radiocarpal joint, characterized as a total dislocation, is very rare, with only six cases reported. Dislocated lunate are generally located around the radiocarpal joint or within carpal ligament. However, there have been no reports of dislocated lunate over the carpal ligament. We present a patient with volar dislocation of the lunate that featured extreme migration to approximately 6 cm proximal to flexor digitorum superficialis through the transcarpal ligament.
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Affiliation(s)
- Jun-Mo Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, South Korea
| | - Jong-Kil Kim
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, South Korea
| | - Kwang-Bok Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, South Korea.
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27
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Yao YC, Wang JP, Huang TF, Chang MC, Huang YC. Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrist. J Chin Med Assoc 2017; 80:117-120. [PMID: 27839956 DOI: 10.1016/j.jcma.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Four-corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure. METHODS We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow-up period was 44.5 months (range, 22-68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion-extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded. RESULTS Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion-extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies. CONCLUSION Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain-free wrist. Moreover, these results were maintained at follow-up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four-corner fusion for advanced degenerative osteoarthritis of wrists.
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Affiliation(s)
- Yu-Cheng Yao
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jung-Pan Wang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tung-Fu Huang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Chao Huang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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28
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Abstract
Thirty-nine patients were retrospectively reviewed after a wrist arthrodesis using a Synthes wrist fusion plate and iliac crest bone graft. Information was obtained from review of patient files, a questionnaire to assess pain, function and work status, and clinical assessment of grip strength, forearm rotation and fingers motion. All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. Thirty-seven patients were satisfied with the procedure, noting a reduction in wrist pain after fusion, but all reported some limitation of function. The wrist fusion plate was removed in six patients and a further four patients experienced minor symptoms over the dorsal aspect of the middle finger metacarpal.
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Affiliation(s)
- B M Meads
- Hand Unit, St Luke's Hospital Complex, Potts Point, NSW 2011, Australia.
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29
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Kasture S, Sakamuri R. Translunate, Transradial, Transtriquetral, Transtrapezoid Perilunate Dislocation With Multiple Metacarpal Neck Fractures. Am J Orthop (Belle Mead NJ) 2017; 46:E435-E438. [PMID: 29309459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a rare case of translunate, transradial, transtriquetral, transtrapezoid perilunate dislocation with multiple metacarpal neck fractures in a young adult. The injury was treated with open reduction and internal fixation. Although the injury was severe, the patient had a satisfactory functional result.
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Affiliation(s)
- Sarang Kasture
- Department of Trauma and Orthopaedics, Gwynedd Hospital, Penrhosgarnedd, Bangor, United Kingdom.
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30
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Mahjoub S, Dunet B, Thoreux P, Masquelet AC. Transverse translunate fracture-dislocation: A rare injury. Hand Surg Rehabil 2016; 35:220-224. [PMID: 27740466 DOI: 10.1016/j.hansur.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/13/2016] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
Perilunate fracture-dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture-dislocation. The patient returned to normal activities after 6 months.
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Affiliation(s)
- S Mahjoub
- Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Service de chirurgie orthopédique et traumatologique, hôpital de Libourne, 112, rue de la Marne, 33505 Libourne, France
| | - B Dunet
- Unité membre supérieur, service de chirurgie orthopédique et traumatologique, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Service de chirurgie orthopédique et traumatologique, hôpital de Libourne, 112, rue de la Marne, 33505 Libourne, France.
| | - P Thoreux
- Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A C Masquelet
- Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
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31
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El Assil O, Tatar M, Uzel AP. Floating forearm with pure dislocations. Hand Surg Rehabil 2016; 35:225-228. [PMID: 27740467 DOI: 10.1016/j.hansur.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/03/2016] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
Affiliation(s)
- O El Assil
- Orthopaedic Surgery and Traumatology departement, University Hospital of Pointe-à-Pitre/Abymes, BP 465, Pointe-à-Pitre, Guadeloupe.
| | - M Tatar
- Orthopaedic Surgery and Traumatology departement, University Hospital of Pointe-à-Pitre/Abymes, BP 465, Pointe-à-Pitre, Guadeloupe
| | - A-P Uzel
- Orthopaedic Surgery and Traumatology departement, University Hospital of Pointe-à-Pitre/Abymes, BP 465, Pointe-à-Pitre, Guadeloupe
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32
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Liu B, Chen SL, Zhu J, Wang ZX, Yang C, Shen J, Tian GL. [Arthroscopic management of lesser arc perilunate injuries]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:234-236. [PMID: 27080273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the outcomes of lesser arc perilunate injuries (Perilunate dislocations) treated with arthroscopically assisted mini-invasive reduction and fixation. METHODS Between 2012 and 2014, 5 patients who had a perilunate dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 17.8 months (range, 10 to 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 questionnaire; and patient-rated wrist evaluation score. Radiographic evaluations included carpal alignments and any development of arthritis. RESULTS The range of flexion-extension motion of injured wrist averaged 84% of the values for contralateral wrist. The grip strength of the injured wrist averaged 90% of the values for the contralateral wrists. The mean Quick Disabilities of the arm, shoulder and hand score was 1, and the mean Patient-Rated Wrist Evaluation score was 5. According to the Mayo wrist scores, the overall functional outcomes were rated as excellent in all the patients. Reduction obtained during the operation was maintained within normal ranges in all the patients. Arthritis had not developed in any patient at the end of the follow-up. CONCLUSION Arthroscopic mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate dislocations according to our early results.
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Affiliation(s)
- B Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - S L Chen
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - J Zhu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Z X Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - C Yang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - J Shen
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - G L Tian
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
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Marcuzzi A, Leigheb M. Transcapho perilunate dislocation with palmar extrusion of the scaphoid proximal pole. Acta Biomed 2016; 87 Suppl 1:127-130. [PMID: 27104332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
Perilunate fracture-dislocations usually combine ligament ruptures, bone avulsions, and fractures in different patterns. Rarely a displaced fracture of the scaphoid can coexist with a scapho-lunate dissociation and can result in enucleation of the proximal pole. We report about a case of trans-scaphoid perilunate dislocation with palmar extrusion/enucleation of the scaphoid proximal pole, treated with scaphoid fracture open reduction and internal fixation with screw, scapho-lunate ligament repair with an anchor and vascularization of the scaphoid proximal pole with the 2nd intermetacarpal artery. At 52 months follow up we had good clinical and radiographic results. In conclusion, scientific literature including our experience about this rare complex lesion of the wrist is too weak to support an effective strategy of management but we think that the careful analysis of the single problems can be the key to solve the complexity. Goal of the treatment should be complete revascularization and healing of the scaphoid, avoiding non union and avascular necrosis; simultaneously a proper ligament reconstruction is fundamental to re-establish carpal stability. Prevention of carpal collapse for a SNAC o SLAC situation is essential to reach a good level of Quality of Life and satisfaction of the patient.
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Abstract
UNLABELLED Lunotriquetral ligament injury is a relatively common cause of ulnar-sided wrist pain. Injury ranges from partial stable ligament tears to extensive perilunate instability. Clinical decision-making largely depends on the chronicity, instability and cause of the ligament injury. Conservative treatment is generally regarded as first choice of treatment of mild lunotriquetral instability; however, outcome studies on conservative treatment are lacking. Temporary arthroscopic pinning and/or debridement are minimally invasive procedures of preference. In the case of more dissociative injury, surgical interventions may be performed. The literature suggests that soft tissue reconstruction is an effective procedure in this group. Arthrodesis of the lunotriquetral joint is associated with high rates of non-union (up to 57%) and the indications for surgery should therefore be very clear. Methodological issues make it hard to draw firm conclusions from the data. Studies on the effectiveness of conservative management and prospective comparative studies will further improve clinical decision-making in lunotriquetral instability. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- T C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands The Hand Clinic, Amsterdam, The Netherlands
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Kara A, Celik H, Seker A, Kilinc E, Camur S, Uzun M. Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors. Int J Surg 2015; 24:57-63. [PMID: 26542987 DOI: 10.1016/j.ijsu.2015.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/23/2015] [Accepted: 10/24/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Perilunate injuries are rare entities which can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). The purpose of treatment is anatomic reduction and stable fixation. We aimed to present the radiologic and functional results of surgically treated dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis. METHODS Between 2007 and 2013, 17 patients were operated for perilunate fracture-dislocations. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated by comparing with contralateral side on plain x-ray images in terms of radiologic evaluation. RESULTS Mean follow-up was 37,8 (range, 16-84) months. The average age at surgery was 35.1 (range, 18-51) years. Fifteen patients were male and two were female. Functional results were excellent in four (23.5%), good in two (11.8%), satisfactory in five (29.4%) and poor in six (35.3%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 14 wrists (82.4%). Scapholunate dissociation more than 2 mm was detected in three wrists. In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results. CONCLUSION Despite anatomic reduction, ligamentous and chondral injuries that occured at the time of trauma may cause persistant wrist pain in patients who suffer perilunate fracture dislocation. Mechanism of injury, presence of soft tissue defects and the time between injury and treatment can affect clinical and radiologic results.
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Affiliation(s)
- Adnan Kara
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Goztepe, Metin Sk. No: 4, 34214 Bagcılar, Istanbul, Turkey
| | - Haluk Celik
- Department of Orthopaedics and Traumatology, Zonguldak Ataturk State Hospital, Mesrutiyet Mahallesi Huzur Sokak No:35, 67030, Zonguldak, Turkey.
| | - Ali Seker
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Goztepe, Metin Sk. No:4, 34214 Bagcılar, Turkey
| | - Eray Kilinc
- Department of Orthopaedics and Traumatology, Igdir State Hospital Kisla Mh., 76000 Igdir, Turkey
| | - Savas Camur
- Department of Orthopaedics and Traumatology, International Hospital, Istanbul Cad. No: 82, Yesilkoy, 34030 İstanbul, Turkey
| | - Metin Uzun
- Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, Darussafaka Mh., Buyukdere Cad. No: 40 Maslak, 34457 Sariyer, Istanbul, Turkey
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Abstract
Although the true incidence of scapholunate interosseous ligament (SLIL) injury is unknown, a study found that 35% of cadaveric wrists had some degree of scapholunate tear. Of those wrists with SLIL injury, 29% had evidence of arthrosis. Early recognition and treatment of these injuries can delay or prevent the onset of arthritis. This article details treatment options for SLIL injury across the spectrum of pathology with a particular emphasis on chronic scapholunate repair and reconstruction. New techniques and outcomes data also are presented.
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Affiliation(s)
- Brett F Michelotti
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| | - Joshua M Adkinson
- Section of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, NMH/Galter Room 3-150, 251 E Huron, Chicago, IL 60611, USA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Langner I, Fischer S, Eisenschenk A, Langner S. Cine MRI: a new approach to the diagnosis of scapholunate dissociation. Skeletal Radiol 2015; 44:1103-10. [PMID: 25761726 DOI: 10.1007/s00256-015-2126-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the feasibility of cine MRI for the detection of scapholunate dissociation (SLD) and to compare the sensitivity and specificity of cine MRI with those of cineradiography and arthroscopy. MATERIALS AND METHODS To evaluate feasibility, healthy subjects underwent cine MRI of the wrist. To evaluate sensitivity and specificity, patients with clinically suspected scapholunate ligament (SLL) injury after trauma to the wrist were prospectively included and underwent radiographic examination, cineradiography, and cine MRI. In 25 out of 38 patients, subsequent arthroscopy was performed. Results of cineradiography and cine MRI correlated with those of arthroscopy. RESULTS Cine MRI was of diagnostic quality in all healthy subjects and patients with good interrater agreement. There was excellent correlation between cineradiography and cine MRI. Scapholunate distance differed significantly between healthy subjects and patients with scapholunate dissociation (p < 0.001), but not between imaging modalities in the patient group. Cine MRI had 85% sensitivity and 90% specificity for the detection of SLD. CONCLUSION Cine MRI of the wrist is a fast and reliable technique for the detection of SLD with diagnostic accuracy comparable to cineradiography. It can be easily implemented as a routine clinical MRI examination, facilitating diagnostic workup of patients with suspected SLD while avoiding radiation exposure.
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Affiliation(s)
- I Langner
- Division of Hand Surgery and Functional Microsurgery, Department of Trauma and Reconstructive Surgery, University Medicine Greifswald, Greifswald, Germany
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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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Wilke B, Kakar S. Delayed Avascular Necrosis and Fragmentation of the Lunate Following Perilunate Dislocation. Orthopedics 2015; 38:e539-42. [PMID: 26091230 DOI: 10.3928/01477447-20150603-92] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/24/2014] [Indexed: 02/03/2023]
Abstract
Perilunate and perilunate fracture dislocations are high-energy injuries with the wrist loaded in extension, ulnar deviation, and intercarpal supination. The force vector travels from a radial to a ulnar direction and can result in complex carpal instability. The diagnosis is often delayed, which can result in suboptimal outcomes. Nonoperative management can produce inferior results, with patients experiencing pain and weakness. Therefore, early treatment with open reduction and internal fixation is recommended to assess the osteochondral and ligamentous disruption and to achieve anatomic reduction of the carpus. Despite this, these patients can develop radiographic degenerative joint disease, which can be seen in up to 90% of cases. This can be due to difficulty in holding and maintaining carpal reduction. Increased radiodensity of the lunate following these injuries has been observed but is believed to be a transient phenomenon without risk of progression to avascular necrosis. This may be due to the blood supply of the lunate, which has varied patterns of intraosseous and extraosseous vascularity. The authors report a patient who developed avascular necrosis and delayed lunate fragmentation following a May-field Type IV perilunate dislocation. This finding highlights the importance of long-term follow-up with these patients.
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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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Lüninghake FJ. [Checklist: wrist fractures]. MMW Fortschr Med 2015; 157:53. [PMID: 25743303 DOI: 10.1007/s15006-015-2589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Alison Kitay
- Department of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Boston, MA.
| | - Chaitanya Mudgal
- Department of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Boston, MA
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Rohman L, Hebron A. Perilunate fracture dislocation. J Emerg Med 2014; 47:e90-e93. [PMID: 24746911 DOI: 10.1016/j.jemermed.2013.08.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 06/03/2023]
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Zhou Y, Liu S, Yu L, Liao Q, Huang T, Zhang C. [Kirschner wire fixation in three joints combined with bone anchor repair for treatment of acute perilunate injury ]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:1086-1090. [PMID: 25509771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint combined with bone anchor repair for the treatment of acute perilunate injury. METHODS Between January 2007 and January 2012, 35 cases of acute perilunate injury were treated. There were 30 males and 5 females with an average age of 45.5 years (range, 32-56 years). Fractures were caused by falling from height in 18 cases, by traffic accident in 11 cases, and by fall injury in 4 cases. The time from injury to operation was 2-6 days (mean, 3.4 days). There were 23 cases of trans-scaphoid perilunate dislocation, 10 cases of perilunate dislocation, and 2 cases of trans-triangular perilunate dislocation. Associated injuries included median nerve injury in 6 cases, radius styloid fracture in 8 cases, ulnar styloid fracture in 2 cases, and distal tibial fracture in 1 case. All the patients were treated by open reduction, Herbert screw fixation of scaphoid fractures, and Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint, and the intercarpal ligaments were repaired by Mitek bone anchor. RESULTS Superficial wound infection occurred in 2 cases, and primary healing of incision obtained in others. Thirty-five patients were followed up 12-35 months (mean, 18 months). X-ray films showed fracture union in 21 cases of scaphoid fractures, and bone nonunion in 2 cases of scaphoid fractures. During the follow-up period, there was no avascular necrosis ofscaphoid or lunate. At last follow-up, the scapholunate angle, radiolunate angle, and wrist range of motion (ROM) in extension had no significant difference between affected and unaffected sides (P > 0.05). The wrist ROM in flexion and grip strength of affected side were not up to the levels of unaffected side (P < 0.05). According to the modified Mayo wrist scoring system, the score was 79.9 ± 10.7, which were excellent in 8 cases, good in 17 cases, fair in 7 cases, and poor in 3 cases, and the excellent and good rate was 71.4%. The disability of arm-shoulder-hand (DASH) questionnaires score was 21 ± 10. Traumatic osteoarthritis was observed in 2 cases. CONCLUSION Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint combined with bone anchor repair for the treatment of acute perilunate injury can get early stability of the carpal joint, favorable intercarpal ligament repair, and good recovery of wrist joint function.
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Suzuki D, Ono H, Furuta K, Katayama T, Akahane M, Omokawa S, Tanaka Y. Comparison of scapholunate distance measurements on plain radiography and computed tomography for the diagnosis of scapholunate instability associated with distal radius fracture. J Orthop Sci 2014; 19:465-70. [PMID: 24473829 DOI: 10.1007/s00776-014-0533-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate radiographic criteria for scapholunate instability (SLI) in the setting of distal radius fracture (DRF) confirmed by arthroscopy. METHODS Eighty-eight wrists with DRF treated by open reduction and internal fixation and assessed for SLI arthroscopically were evaluated. The scapholunate distance (SLD) was measured by preoperative posteroanterior wrist radiography and computed tomography (CT). SLD on radiographs was measured as the distance between the scaphoid cortex and the lunate cortex at the center of the scapholunate joint. SLDs were measured at the volar end (A1), center (A2), and dorsal end (A3) of the scapholunate joint on the central CT axial slice; and at the proximal end (C1), center (C2), and distal end (C3) of the scapholunate joint on the central CT coronal slice. Wrists were divided into three groups by arthroscopic assessments: stable (normal, Geissler grade 1 or 2), G3 (Geissler grade 3), and G4 (Geissler grade 4). SLD measurements on radiographs and CTs (A1-C3) were compared among the three groups. Receiver-operating characteristic (ROC) curve analyses were performed to evaluate the abilities of SLD measurements on radiographs and CTs to identify SLI in wrists with DRF. Interobserver and intraobserver reliabilities of SLD measurements on radiographs and CTs were analyzed by intraclass correlation coefficients (ICCs). RESULTS SLDs of C3 differed significantly among the G3 and G4 groups, and among the stable and G4 groups. The area under the curve on ROC curve analysis was 0.855 for the SLD of C3, which was larger than that for SLD on radiographs. For C3, the intraobserver ICC was 0.832 and interobserver ICC was 0.73. CONCLUSIONS SLD at the distal end of the scapholunate joint on the central coronal CT slice was the most appropriate measurement for discrimination of Geissler grade 4 SLI in wrists with DRF. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Daisuke Suzuki
- Department of Orthopaedic Surgery, Kokuho Central Hospital, 404-1 Miyako, Tawaramoto, Nara, 636-0302, Japan,
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Lo BM, Kerns B. Bilateral perilunate dislocation after a fall. J Emerg Med 2014; 46:223-224. [PMID: 24113485 DOI: 10.1016/j.jemermed.2013.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Bruce M Lo
- Department of Emergency Medicine, Eastern Virginia Medical School/Sentara Norfolk General Hospital, Norfolk, Virginia
| | - Brian Kerns
- Department of Emergency Medicine, Eastern Virginia Medical School/Sentara Norfolk General Hospital, Norfolk, Virginia
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47
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Abstract
We experienced two cases of simultaneous fracture of the scaphoid and the lunate. In two cases, both scaphoid and lunate fractures existed on the same plane, which may help us to understand the mechanism of proximal fracture of the scaphoid.
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Affiliation(s)
- Tetsuhiro Asano
- Department of Orthopaedic Surgery, Jinno Hospital, Himeji, Hyogo, Japan
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Zyluk A, Piotuch B, Puchalski P. Outcome of treatment of complex, perilunate fracture-dislocation of the wrist: a case report. Pol Orthop Traumatol 2013; 78:41-45. [PMID: 23348402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Complex, perilunate fracture-dislocations of the wrist comprise severe and challenging injuries, characterised by a total loss of contact between the lunate bone and the head of the capitate as well as fracture of one, or more bones surrounding lunate bone. The principle of treatment of such injuries involves stable fixation of fractures, anatomical reduction of the displaced carpal bones with temporary arthrodesis wit K-wires to maintain their position. We present a patient who sustained a complex, perilunate fracture-dislocation of the wrist with fractures of the scaphoid, hamate and base of the IV metacarpal bone, as a result of a blast. Assessment at one year after the surgery showed satisfactory result: mean range of motion in the wrist was 50-60% of the healthy side, grip strength was 55%, DASH score of 36 and Mayo score of 65.
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Affiliation(s)
- Andrzej Zyluk
- Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland.
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