Ligament reconstruction using rivet for treatment of trans-radius perilunar dislocations

Abstract

Objective To evaluate application of rivet for ligament reconstruction in the treatment of trans-radius perilunar dislocations (TRPD). Methods From February 2007 to May 2014, 9 cases of TRPD were treated. They were divided into three types according to the fracture site: type Ⅰ for dorsal radius, type Ⅱ for radial styloid, type Ⅲ for dorsal radius and radial styloid. All 9 patients were surgical treated using rivet for ligament reconstruction. Patients were evaluated postoperatively by measuring the range of motion of the wrist and grip strength, wrist radiography for fracture healing and signs of post-traumatic arthritis. The Mayo wrist score was assessed. Results There were 4 cases of type Ⅰ, 4 cases of type Ⅱ and 1 case of type Ⅲ. The first radiography diagnosis was inaccurate in 3 cases. Surgical open reduction, internal fixation and ligament repair were carried out in all patients under brachial plexus block. All patients were follow-up for 10 to 26 months with a mean period of 18 months. The final outcome was excellent in 3 cases, good in 4, and fair in 2 according to the Mayo wrist score. The average range of flexion and extension motion was 109.4°and the mean grip strength was 84.2% of the uninjured wrist. Two patients suffered slight pain. Aseptic necrosis of the lunate occurred in 1 case. No post-traumatic arthritis and nonunion were present on X-rays. Conclusion Ligament reconstruction using rivet can achieve a satisfactory outcome for treatment of trans-radius perilunar dislocations. Key words: Dislocations; Treatment outcome; Rivet; Ligament reconstruction