Mid- to Long-Term Clinical and Radiological Outcome after Perilunate Injuries

Abstract

Abstract Background Perilunate dislocations (PLD) and perilunate fracture dislocations (PLFD) are rare but severe injuries to the wrist, usually resulting from a high-energy trauma occurring in sports injuries, motor vehicle accidents, falls or machine related accidents. Treatment of choice is early reduction with carpal transfixation, fracture fixation and refixation of the injured ligaments. Aims As reports on mid- to long-term outcome are scarce, we aimed to investigate clinical and radiological outcome of open treatment after a minimal follow-up of 2 years. Methods Patients treated for PLD and PLFD in our institution were identified back to 2008. Inclusion criteria were PLD and PLFD who underwent open surgery, had a minimal follow-up of 2 years and were available for a follow-up. Clinical examination included ROM and grip strength. PRWE, quick DASH, SF-12 and the single assessment numeric evaluation (SANE) score were used as PROMs. Dorso-palmar and lateral X-rays were done and assessed for carpal height, inter- and radio-carpal angles and degenerative changes. Results Of 54 identified patients, 29 patients could be located and contacted. By the date of abstract submission 15 patients after PLFD and 9 after PLD had been followed-up in our clinic. Mean follow-up was 93 months (24-170). Mean F/E was 43/0/51° for the affected and 68/0/66° for the healthy wrist, P/S 77/0/73° and 79/0/79°, R/U 24/0/34° and 27/0/44°. Mean grip strength was 41kp and 61kp. Mean score for PRWE was 13.2, qDASH 14.2%, SF-12 physical score 50.9, mental score 55.1 and SANE 86%. 11 patients showed slight to moderate degenerative changes. Carpal height (Nattrass Index) showed a mean of 1.45. Conclusions Although the affected wrists showed reduced ROM and SANE scores, patients were mostly satisfied with the outcome and only exhibited little pain. Open reduction and fixation of PLD and PLFD reliably lead to satisfactory results even in the long-term.