In Reply

Abstract

We thank the reader for the insightful comments and for highlighting several papers1Kailu L. Zhou X. Fuguo H. Chronic perilunate dislocations treated with open reduction and internal fixation: results of medium-term follow-up.Int Orthop. 2010; 34: 1315-1320Crossref PubMed Scopus (9) Google Scholar, 2Garg B. Goyal T. Kotwal P.P. Staged reduction of neglected transscaphoid perilunate fracture dislocation: A report of 16 cases.J Orthop Surg Res. 2012; 7: 19Crossref PubMed Scopus (12) Google Scholar, 3Lal H. Jangira V. Kakran R. Mittal D. Two stage procedure for neglected transscaphoid perilunate dislocation.Indian J Orthop. 2012; 46: 351-355Crossref PubMed Scopus (4) Google Scholar (2 of which were published after our manuscript was submitted) addressing the particularly challenging subset of perilunate injuries presenting to the hand surgeon late. Massoud and Naam also recently reported their experience with open reduction internal fixation of perilunate dislocations and fracture dislocations that were treated 13 to 35 weeks from the time of injury, with good to excellent results in 11 of 19 patients.4Massoud A.H. Naam N.H. Functional outcome of open reduction of chronic perilunate injuries.J Hand Surg Am. 2012; 37: 1852-1860Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Although these studies represent relatively small series, they do demonstrate that successful outcomes can be achieved with single-stage or double-stage open reduction internal fixation procedures in the treatment of chronic perilunate injuries. However, the carpus should be easily reducible at the time of surgery, or any form of ligamentous repair can be prone to failure with time. Although these series have not demonstrated loss of intercarpal reduction over time, repair of the intercarpal ligaments can prove challenging secondary to their attenuation and contracture related to the chronicity of the injury. In addition, the articular cartilage must be evaluated at the time of surgery. Kailu et al noted, “With no exception, cases with excellent or good results in this study had satisfactory cartilage condition of the midcarpal joints when evaluated during the operation,” and 2 patients with poor outcomes had been noted to have severe scaphoid and lunate cartilage contusion at the time of open reduction.1Kailu L. Zhou X. Fuguo H. Chronic perilunate dislocations treated with open reduction and internal fixation: results of medium-term follow-up.Int Orthop. 2010; 34: 1315-1320Crossref PubMed Scopus (9) Google Scholar Therefore, in the setting of severe chondral injury, arthritis, or avascular necrosis associated with a neglected perilunate injury, a salvage procedure must remain an option and might be more reliable and durable in young, active patients. Letter Regarding “Perilunate Dislocations and Fracture Dislocations”Journal of Hand SurgeryVol. 38Issue 1PreviewWe read with great interest the article by Jones and Kakar.1 It nicely covers the whole spectrum of perilunate dislocations and fracture dislocations. The author did not mention the treatment for dislocations in patients who present late. The treatment mentioned is about the salvage procedure directly. It is mentioned in the literature that open reduction internal fixation in a single stage2 as well as in a 2-staged procedure3 is a satisfactory procedure if executed properly in patients who present late. Full-Text PDF