Perilunate Fracture Dislocations Research Articles

Surgical management and functional outcomes of perilunate dislocations and fracture dislocations through the dorsal approach.

Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6weeks, 12weeks, 6months, 1year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Retrospective case series study.

Reverse or Ulnar-Sided, Greater Arc Perilunate Injury: Case Report and Systematic Review of Literature.

Perilunate injuries of carpal bones are uncommon, high-energy injuries that necessitate early diagnosis and appropriate management to prevent progressive carpal instability and posttraumatic osteoarthritis. A much more uncommon mechanism that starts from the lunotriquetral ligament and proceeds radially in an opposite direction than the classic mechanism may cause a reverse or ulnar-sided perilunate dislocation (PLD). The purposes were: (1) to present an uncommon case of greater arc reverse (ulnar-sided) perilunate fracture-dislocation (REPLFD); and (2) to conduct a systematic review (SR) to evaluate the current evidence on reverse perilunate injuries (REPLIs). A novel pattern of injury of REPLFD with fractures of the ulnar styloid, triquetrum, and capitate is presented. A SR was conducted with primary outcome measures of the type of injury (pathoanatomy of lesions) and pathomechanics. Secondary outcome measures were choice of surgery and outcome on follow-up. The Murad's tool and modified Coleman Methodology Score revealed poor methodological quality of the available literature on REPLI. Evidence is lacking in the mechanism of injury and treatment of REPLI, especially regarding REPLFD. The SR revealed poor methodological quality of the available literature and exposes that not all PLDs can be explained by the current existing pathomechanical injury classifications. However, following the management principles of perilunate injuries, REPLI tends to have good functional results with no major complications. Level V.

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

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.

A Novel Mini-Invasive Technique of Arthroscopic-Assisted Reduction and Robot-Assisted Fixation for Trans-Scaphoid Perilunate Fracture Dislocations.

Perilunate injuries are rare but devastating carpal injuries. The treatment of perilunate injuries remains challenging and contentious. This study aims to describe a novel mini-invasive surgical technique of arthroscopic-assisted reduction and robot-assisted fixation for the treatment of trans-scaphoid perilunate fracture dislocations (PLFDs). We retrospectively reviewed patients with PLFDs after surgical treatment from February 2021 to March 2021. The patients underwent arthroscopic-assisted precise reduction and robot-assisted headless screw fixation. Times of guide wire placement were recorded intraoperatively. Periodic follow-up was performed until union of scaphoid fracture was confirmed. Range of motion of the wrist, grip strength, the Visual Analog Scale (VAS) score, the Mayo Wrist Score, the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE), and osteoarthritis were evaluated at the final follow-up. Two male patients presenting with PLFDs with an average age of 24.5 years old (32 and 17 years) were included in this study. Intraoperatively, anatomic reduction of the scaphoid fracture was achieved under arthroscopic guidance. A robotic-assisted single-attempt guidewire insertion was performed for scaphoid fracture and lunotriquetral interval. The CT scans at 8 and 12 weeks showed the union of the scaphoid fracture. At final mean follow-up of 13.5 months, the extension, radial-ulnar deviation, and pronation-supination were consistent with the contralateral side in both patients. One patient experienced mild limited range of motion with the flexion 46° of the injured wrist compared with 81°of the contralateral wrist. The VAS score was 0 and 2. The grip strength was 32 and 26 kg compared with 24 and 42 kg of the contralateral wrist. The PRWE score was 13 and 10 and the QuickDASH score was 2 and 7. The Mayo Wrist Score was 100 and 65. No sign of osteoarthritis was found at the last follow-up. Arthroscopic-assisted reduction and robot-assisted fixation is a viable and promising alternative for the treatment of perilunate fracture dislocations. This technique allows precise reduction and accurate placement of the K-wires/screws into the carpal bones through the optimal biomechanical paths.

AN ACUTE COMPLEX PERILUNATE DISLOCATION WITH DEPRESSED DISTAL RADIUS FRACTURE - A CASE REPORT

Introduction Perilunate dislocations and fracture–dislocations are the most common forms of wrist dislocation and encompass a spectrum of injuries, which can include both ligamentous and osseous disruption. In clinical practice, the prex trans is commonly used to refer to associated fractures, whereas the prex peri- is used to describe a dislocation. Perilunate fracture–dislocations (greater arc injuries) are more frequently seen than perilunate dislocations (lesser arc injuries) with the ratio reported to be two to one, with displacement in a dorsal direction in 97% of cases. Here we present a case of 32 year old male with perilunate fracture dislocation with depressed distal radius fracture, which was managed by open dorsal approach with proper reduction, k wire xation and good functional outcome

Short-term outcomes of perilunate dislocations and perilunate fracture-dislocations: a single-center retrospective study

Background: Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are rare, but serious wrist injuries. This study reports the radiographic and clinical outcomes of PLD/PLFD in a series of 30 patients. Methods: Thirty patients with PLD (n=4) or PLFD (n=26) and a mean follow-up of 17.2 mo (range 12 to 21) were included in this retrospective study. Radiographic outcomes included the scapholunate angle, scapholunate interval, and carpal height ratio. Clinical outcomes included the wrist range of motion (ROM), pinch, and grip strength. Wrist function was assessed by a modified Mayo wrist score. Results: At the final follow-up, the scapholunate angle and interval were above the normal value in 10 and three patients, respectively. The carpal height ratio was normal in all patients. The mean wrist flexion was 44.2±15.8 degrees. The mean wrist extension was 28.3±15.4 degrees. The mean radial deviation was 14.3±4.3 degrees. The mean ulnar deviation was 18.4±6.3 degrees. The mean grip strength was 50.4±11.6 lb. in the involved wrist and 54.6±13.3 lb. in the noninvolved wrist (P=0.27). The mean pinch strength was 9.1±2.1 lb. in the involved wrist and 9.5±1.8 lb. in the noninvolved wrist (P=0.15). The mean modified Mayo score of the patients was 65.5±10. Postoperative stiffness, pain, and carpal instability were observed in six, five, and nine patients, respectively. Conclusions: Surgical treatment of PLD/PLFD provides satisfactory radiographic outcomes. Clinical outcomes seem to be less satisfactory, even after prompt diagnosis and treatment. Level of Evidence: Level IV

PERILUNATE INSTABILITY AND DISLOCATION: A COMMONLY MISSED DIAGNOSIS

Perilunate dislocations and perilunate fracture-dislocations are high-energy wrist injuries, characterized by a spectrum of bony and ligamentous damage. Clinical presentation often includes decreased range of motion, swelling and pain, and a palpable wrist deformity, while radiographic evaluation of the wrist may reveal abnormal radiocarpal and intercarpal collinearity and bony insult. This particular trauma may be difficult to detect due to nonspecific clinic presentation and subtle imaging findings, and can be missed in up to 25% of initial evaluations. Prompt recognition is essential for optimal patient outcomes, as the majority of patients are young adults and thus duration of disability is significant.

Long-term results of trans-scaphoid perilunate fracture dislocations treated by open reduction and internal fixation

PurposeThe paper holds the research purpose of confirming the long-term results of trans-scaphoid perilunate fracture dislocations (TSPFD) under the treatment of open reduction and internal fixation.MethodsAnteroposterial-lateral radiographs of the patient's wrist were taken before and after surgery. We use a dorsal approach for all cases. Postoperative clinical and radiographic assessments were performed routinely. The scapholunate angle (SLA), estradiol angle (RLA), as well as lunotriquetral distance (LTD) assisted in the radiographic assessment. Clinical assessment was performed using the Krimmer score, modified Mayo wrist score (MWS), active flexion extension arc (FEA), radial deviation and ulnar deviation arc (RUDA) and grip strength. A visual analog scale (VAS) assisted in the pain evaluation, the VAS score ranges from 0 to 10.ResultsTwenty-two TSPFD patients due to the wrist trauma received operative treatment and we retrospectively analyzed the surgical results, together with evaluating their clinical and radiological follow-up. These patients held a mean age of 30 years old. Herzberg’s perilunate fracture-dislocation classification was taken into account to find that 19 males and 3 females suffered dorsal dislocation. The fellow-up time lasted 98.3 months on average. All cases obtained sufficient union after open reduction and internal fixation. The last follow-up found the median of grip strength was 20.00 (interquartile range, 20.00–21.25), which was 84.5% of the normal side. The modified Mayo wrist score evaluation scale considered 12 cases as excellent, and 10 good. The median of VAS and Krimmer scores at the final follow-up were 1.50 (interquartile range, 0.75–2.00) and 100.00 (interquartile range, 100.00–100.00), respectively, higher relative to the pre-operation (P < 0.001). No patients showed nerve damage preoperatively or postoperatively, or pin tract infection in any of the patient.ConclusionsIt is necessary to diagnose such complicated biomechanical damage in early stage and adopt the open reduction and stable fixation for treatment; appropriate treatment can contribute to a functionally adequate and anatomically integrated wrist.

Perilunate Injury Timing and Treatment Options: A Systematic Review.

Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.

Trans-Scaphoid Perilunate Fracture Dislocation with Ipsilateral Terrible Triad Injury of The Elbow: Case report

ABSTRACT Background: Complex elbow dislocations are injuries in which there is a significant risk of long-term disability. The combination of elbow dislocation with both radial head and coronoid process fracture is particularly challenging to treat and, as such, has been termed terrible triad injury (TTI) of the elbow. TTI is typically caused by high-energy falls onto an outstretched hand. Case report: A-48-years-old male patient, not known to have any medical illnesses, presented to Emergency Department Orthopedic, King Fahad General Hospital, complaining of right elbow, forearm and wrist pain and deformities after history of fall down directly to his right hyperflexed wrist and extended elbow that resulted in elbow dislocation and ipsilateral transscaphoid perilunate fracture dislocation. Management: Patient was shifted to operation room for open reduction internal fixation. We started with elbow through posterior elbow approach, coronoid reduced that was fixed by two interfragmentry screws. Then for olecranon fracture, through same posterior incision, ulnar nerve was identified and protected and fracture was reduced and fixed with anatomical plate. Elbow stability was checked where it was stable. Then, distal radius open reduction through dorsal approach and internal fixation with LC-DCP was achieved. Additionally, through dorsal approach, lunate dislocation and scaphoid fracture were reduced and fixed with 6 k-wires and spaning external fixator applied from radius to 2nd metacarpal to maintain reduction. Conclusion: In case of right terrible triad injury of the elbow with ipsilateral trans-scaphoid perilunate fracture dislocation, only urgent surgical treatment of both elbow and wrist may achieve good results.

Short-Term Results of Combined Open Reduction and Internal Fixation in the Treatment of Trans-Scaphoid Perilunate Fracture-Dislocation

Short-Term Results of Combined Open Reduction and Internal Fixation in the Treatment of Trans-Scaphoid Perilunate Fracture-Dislocation

Perilunate Dislocations and Fracture-Dislocations: A Retrospective Study of 11 Cases

Perilunate dislocations (PD) and perilunate fracture-dislocations (PFD) of the carpus are rare but important entity in so far as it presents a high risk of after-effects and post-traumatic osteoarthritis. We report a retrospective, monocentric and multioperator series of 11 patients with a mean follow-up of 24 months over a -year period from 2016 to 2020. The objective of our study was to establish an epidemiological profile and to study the clinical, functional and radiological results of PD and PFD of the carpus while underlining the interest of early management. There were 3 pure PDs and 8 trans-scaphoid PFDs with 10 dorsally displaced forms and only one ventrally displaced form. Clinical and functional evaluation was based on mobilities, strength, pain, Cooney Score, Quick-DASH, and PRWE. Radiological abnormalities were analyzed with the Herzberg classification. All patients were treated surgically after closed reduction, with a dorsal approach in 3 cases, and a palmar approach in 8 patients. Early diagnosis and anatomical reduction provide a satisfactory functional result to avoid complications. This implies an emergency open surgical treatment, a close follow-up and a postoperative rehabilitation in the shortest possible time.

Trans-scaphoid Perilunate Fracture Dislocation

Trans-scaphoid perilunate fracture dislocations, which account for more than half of total cases of perilunate injuries, are common in young patients and occur as a result of high-energy injuries, and improper management can impair wrist alignment and function. Understanding the related wrist anatomy and pathomechanics may help surgeons evaluate and diagnose patients. Early operation to reduce and fix the injuries should be considered to achieve optimal clinical and radiological outcomes. In this review article, we present an overview of wrist pathoanatomy, the pathomechanics of trans-scaphoid perilunate fracture dislocations, operative treatment options including an arthroscopic procedure, and reported clinical and radiological outcomes.

Perilunate fracture-dislocations: Clinical and functional outcomes at a mean follow-up of 3.3 years

IntroductionPerilunate lesions in the carpus are severe injuries whose functional consequences can limit patients’ ability to regain their pre-injury activity levels. The aim of this study was to evaluate the outcomes of a series of patients who suffered a perilunate fracture-dislocation and to assess their ability to resume their social and professional activities. HypothesisAfter surgical management of this injury, the medium-term functional outcomes will allow patients to return to their pre-injury social and professional activities. Materials and methodsThis was a single center, retrospective study. Included patients were adults who had suffered a perilunate fracture-dislocation that was treated emergently. The clinical and functional assessment consisted of comparing the mobility and grip strength between the injured and contralateral wrists, determining the functional outcome scores and the resumption of social and professional activities. A radiological assessment was done to look for instability of the proximal row of the carpus, nonunion or necrosis of the carpal bones, loss of carpal height, and presence of carpal osteoarthritis. ResultsTen patients were included with a mean follow-up of 39.4 months. The mean flexion/extension arc decreased significantly to 88° (20°–150) which was 55% of the healthy contralateral side (p=0.0026) while the grip strength decreased but not significantly (40.6 Kg vs. healthy side 62.4 Kg, p=0.063). The mean MWS was 58.75 (40-100), the mean PRWE was 32.9 (4–67.5) and the mean QuickDASH was 30.2 (0–77). Six of the ten patients (60%) were able to return to work, although three required occupational reclassifications. Four patients had signs of proximal row instability. There were seven instances of radiocarpal osteoarthritis, two of which were combined with mid-carpal osteoarthritis. DiscussionThis study found shorter range of motion and worse patient-reported outcomes than other published studies, which may be due to the severity of the perilunate fracture-dislocation injuries and the inclusion of polytrauma patients. Nevertheless, the subjective scores were comparable. These injuries have serious consequences on social and professional activities of manual workers. Level of evidenceIV; retrospective study.

Perilunate fracture-dislocations: definition, diagnosis and treatment

Perilunate fracture-dislocations: definition, diagnosis and treatment

Surgical Outcomes of Perilunate Dislocations and Perilunate Fracture-dislocations: A Review of 20 Cases

Background: Perilunate dislocations and perilunate fracture-dislocations (PLD/PLFD) are the second most common wrist injuries. Objectives: Given the limited available case series due to the rarity of these injuries, in this study, we report the functional outcomes of 20 patients who received surgical treatment with a mean follow-up of 28 months (range 24-36). Methods: We retrospectively reviewed the admissions to Imam Khomeini Hospital Sari, Iran, and included patients with (PLD/PLFD) who underwent surgical treatment between January 2014 to December 2019. We included 20 patients (16 males, mean age±SD=33.6±12.4) who had received urgent surgical treatment following the initial closed reduction in the emergency department. All of the patients received surgical treatment from the same surgical team using the dorsal approach. Results: We observed the average Mayo Wrist Score (MWS) of 73.8±8.4 (range 65-100) with excellent or good outcomes in 40% of patients. The MWS was slightly higher in patients with the non-dominant injured side, yet it did not significantly differ with those with a dominant hand injury (75.4±9.6 vs. 71.2±5.8, P=0.29). Furthermore, we did not find a significant difference in MWS between the lesser and greater arc injuries (76.5±10.1 vs. 71.1±5.7, P=0.15). The observed flexion and extension ROM were significantly lower than the contralateral side (p <0.001). Similar patterns of lower grip and pinch strength were observed on the injured side, which was significantly lower than the contralateral hand; 38.4±8.6 (74±14% of the contralateral) and 9.9±2.4 (81±15% of the contralateral), respectively (p <0.001). Conclusion: In line with other cohorts, the present case series demonstrates relatively good functional postoperative outcomes in PLD/PLFD. Our findings are comparable with prior reports concerning reasonably satisfactory MWS, ROM relative to the contralateral side and reported occasional mild pain with activity. Future studies should be directed to investigate long-term complications associated with these injuries, particularly the development of wrist osteoarthritis.

AB069. SOH21AS126. Screw fixation of coronal plane lunate fractures—an encouraging trend?

Background: Perilunate fracture-dislocations are classically high velocity injuries disproportionately affecting the young. They are associated with high morbidity due to related carpal instability and risk of avascular necrosis of the lunate. Given the relative rarity of the injury, there is no gold standard for management and a number of methods have been explored in the literature. Screw fixation of the lunate is uncommon, with only 4 previous reported cases in this fracture pattern found in the literature. We present our experience with the technique to offer guidance in this rare presentation.

Acute Scaphoidectomy and Lunocapitate Fusion for the Surgical Treatment of Compound Trans Styloid, Trans-Scaphoid, Peri-Lunate Fracture-Dislocation with Extensor Tendon Injury

Compound fracture-dislocations of proximal carpal bones are very rare. We report a 54-year-old male, laborer, who sustained a compound Gustilo Anderson type III-A dorsal wound with trans styloid, trans-scaphoid, peri-lunate dislocation with an extensor tendon injury. The patient underwent primary scaphoidectomy with Lunocapitate fusion with extensor tendon repair. On follow-up after 3 months, the patient had partial recovery of range of motion around the wrist without any significant discomfort. Keywords: Compound fracture-dislocation, Primary proximal row carpectomy, Trans-styloid trans scaphoidperilunate dislocation

Acute four-corner arthrodesis for the treatment of 2 cases of trans-scaphoid perilunate fracture dislocation

Acute four-corner arthrodesis for the treatment of 2 cases of trans-scaphoid perilunate fracture dislocation

Trans-Triquetral Perilunate Fracture Dislocation: Rare Injury Pattern

Perilunate dislocation in the wrist is a rare injury that is missed in 25% of cases[1] with trans-triquetral perilunate fracture dislocation is even rarer. We describe a case of 26 years old healthcare worker who sustained a trans-triquetral perilunate fracture dislocation in his workplace. Emergency reduction under sedation was successfully performed and a near complete range of painless movement was achieved at 8 months follow-up.