Identification et traitement les lesions intra-carpiennes

Abstract

High energy injuries of the wrist may cause perilunate dislocations and fracture-dislocations that may develop in a spectrum of injuries of different severity affecting bone and ligaments, or ligaments alone even without dislocation (PLIND injuries). The use of arthroscopic assistance in treating wrist trauma has allowed the finding of association between bone and intracarpal ligament injuries in high percentage of cases. The aim of this study is to evaluate the results of treatment of multiple intracarpal ligament injuries with without simultaneous internal fixation of carpal bones. Twelve patients were treated since 2008. Of those, eight patients affected by simultaneous scaphoid fracture and SL ligament lesions and four patients with associated scapholunate (SL) and lunotriquetral (LT) ligaments. All were males and the mean age was 34 years old (21–65). All patients were examined under arthroscopy and lesions classified according to Geissler and EWAS Classifications. The scaphoid fractures were treated by screw fixation with or without a graft and the ligaments injuries by capsulodesis open or arthroscopic. The patients were evaluated at a mean follow-up of 11 months (5 months–8 years). The Mayo and DASH scores were used for evaluation at follow-up. Scapho-lunate injuries were Geissler stage III in 8 patients (EWAS IIIC 6 cases, IIIB 2 cases, IIIA 1 case) and a Geissler EWAS stage II in 3 patient. At follow-up, X-rays documented healing of the fracture in all cases. The results were excellent and good according to the Mayo Wrist Score. Grip strength was comparable to contralateral side and patients returned to previous work. One patient reported occasional pain under load at follow-up at 5 months. Two patients treated with dorsal capsulodesis had a slight reduction of flexion. The diagnosis of ligamentous lesions has been evolving in the last years with the diffusion of wrist arthroscopy that allows their direct identification. Nowadays, we know that a spectrum of different ligament lesions can occur and that they can be associated in different ways, still under definition. Our preliminary results are excellent and good and a longer follow-up is needed to correctly evaluate the results in the long term. The increased use of arthroscopic examination of the wrist is advisable in wrist trauma in order to establish a correct diagnosis, prognosis and treatment of all the patient's lesions, possibly preventing degenerative arthritis.