Arthroscopically assisted mini-invasive management of perilunate dislocations and fracture–dislocations

Abstract

The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture–dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range, 6–32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo wrist score; Quick Disabilities of the Arm, Shoulder and Hand questionnaire; and Patient-Rated Wrist Evaluation score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. The range of flexion–extension motion of injured wrist averaged 86% of the values for contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean Quick Disabilities of the Arm, Shoulder and Hand score was 6, and the mean Patient-Rated Wrist Evaluation score was 10. According to the Mayo wrist scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in 1 patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. Level IV, therapeutic.