Surgical Treatment of Acute Perilunate Dislocations and Fracture Dislocations in a Specialized Center

Abstract

Introduction: Acute perilunate dislocations and fracture dislocations are uncommon but severe carpal injuries. Different treatment options have been recommended with a recent trend in open reduction and internal fixation. The purpose of this study is evaluate a cohort of patients who received a specific surgical treatment for acute perilunate dislocations and fracture dislocations of the carpus in the first 72 hours after trauma and with open reduction and internal fixation through isolated dorsal approach in a specialized trauma and hand surgery center, between February 2008 to February 2014. Method: A series of 20 perilunate dislocations and fracture dislocations was studied of which 19 were male and 1 female patient. The average age at time of injury was 32 years (20-48 years), and the upper extremity that most often committed was right (64%). The dominant hand was affected in 80% of cases. The most common mechanism of trauma was traffic accident (90%). Pure perilunate dislocations were more frequent (50%), trans-scaphoid perilunate fracture dislocation (40%) and trans-styloid perilunate fracture dislocations (10%). The average follow-up period was 39.5 months (17-72 months). Results: Patients were assessed subjectively with a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, with average of 3.18 (0-10) and with a standard deviation of ±3.2; and visual analogue scale (VAS) with average score of 1.5 (1-4) and with a standard deviation of ±0.81. Objectively results were assessed by active range of motion with flexion-extension arc averaging 132° with a standard deviation of ±13.6, average supination arc of 154° with a standard deviation of ±5.8 arc, and finally radial and ulnar motion of 39° with a standard deviation of ±8. Two complications were reported in the series, the most serious related with pin tract infection, deep wound infection, and associated with scapholunate dissociation recurrent, and osteoarthritic changes that required additional surgery with proximal row carpectomy. The second complication reported with a residual hematoma in the carpal tunnel that required surgical drainage with later success. Conclusions: Early surgical treatment is considered as important in many studies and a determining factor in obtaining satisfactory clinical and functional results. In this study, all patients were treated timely (less than 72 hours), which we believe was determinant in obtaining excellent average results in the parameters evaluated with evidence of just 2 related complications.