Trans-scaphoid Perilunate Fracture Dislocation Research Articles

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.

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.

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.

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

Closed K-wire Fixation for the Treatment of Perilunate Dislocation and Trans-Scaphoid Perilunate Fracture Dislocations without Ligamentous Repair: Short Term Follow-Up.

The purpose of this study was to evaluate the treatment outcomes of perilunate dislocations (PLDs) and transscaphoid perilunate fracture dislocations (TSPLDs) treated with operative volar approach without ligament repair or reconstruction. A total of seven patients (10 hands) were studied during 2017-2018. We fixed scaphoid fractures thorough a volar approach and 3 k-wires were inserted to stabilize the scaphoid to the adjacent bones. We evaluated patients' range of motion by VAS and grip strength, sensitivity assessment, and radiographs. Mayo and DASH scores were also recorded for wrist evaluation. All fractures united well. The mean Mayo wrist score was 81.5. Five patients scored good and excellent results (90-100). Excellent DASH scores (˂20) were observed in 4 patients and there was no poor DASH score (˃50). Treatment of PLDs and TSPLDs with k-wire and screw fixation using a volar approach and without any ligament repair or reconstruction results in minimal manipulation and has favorable short-term outcomes.

Fracture luxation trans-scapho rétrolunaire dorsale bilatérale – à propos de deux cas

Trans-scaphoid perilunate fracture–dislocations represent a rare injury. These are responsible of one of the most devastating damages of the carpus. These injuries may be easily overlooked or misdiagnosed which deteriorate its prognosis. The aim of this study is to present two unique cases of this injury, comparision to the reported cases and discuss the prognosis factors and treatment options. The first case is a 21-year-old male labourer injured secondary to a motor-cycle accident. Urgent open reduction and stabilization of both wrists was done. Currently, the wrist is stable with functional range of motion and bony union at 18 months. The second case is a 30-year-old male farmer, who presented a polytrauma of after a fall. The patient was referred to our department twelve days after the trauma. Open reduction was first done with a fixation of the carpus and stabilization of the scaphoid were performed using Kirschner wires with ligamentous repair for both wrists. Functional outcomes were satisfactory despite non-union of the scaphoid on one side at two year follow-up. Perilunate dislocations are devastating high-energy wrist injuries. These injuries combine bony avulsions, ligament disruption and fractures in different forms. The present concept of the mechanism of dorsal perilunate dislocation in literature is a fall on outstretched hand with ulnar deviation and supination of the wrist. Dislocation in this region requires rapid realignment, as untreated, it will lead to serious secondary damage. Diagnosis can be difficult as it was missed in our patient, it is frequently the case due to other associated injuries or inadequate interpretation of radiographs of the wrist. Treatment options include closed reduction and cast immobilization, closed reduction and percutaneous pinning, and open reduction. We have performed an open reduction through a dorsal approach with repair of the damaged ligaments and stabilization with K-wires of the carpus and the scaphoid fracture with good functional results for both patients. Early open reduction and restoration of carpal anatomy and repair of damaged ligaments are emphasized in order to restore the complex anatomic inter-carpal anatomy. Non-union rate of the scaphoid was relatively higher in the series treated by closed reduction. These are high velocity injuries and are often missed. Early diagnosis of this entity is essential to prevent complication, through clinical examination and careful evaluation of the radiographs. When detected and treated early patient can have a satisfactory functional outcome.

Management of Acute Trans Scaphoid Peri-Lunate Fracture Dislocation by Closed Reduction and Percutaneous Fixation

Management of Acute Trans Scaphoid Peri-Lunate Fracture Dislocation by Closed Reduction and Percutaneous Fixation

Comparative Outcome Analysis of Arthroscopic-Assisted Versus Open Reduction and Fixation of Trans-scaphoid Perilunate Fracture Dislocations

To compare union rates and clinical and radiological outcomes of arthroscopic-assisted reduction and fixation with those of open reduction and fixation in patients with trans-scaphoid perilunate fracture dislocations. This retrospective study included consecutive patients with trans-scaphoid PLFDs who underwent arthroscopic-assisted reduction and fixation (group A) or open reduction and fixation (group O), and who were followed up for a minimum of 2years between May 2005 and March 2013. We excluded initially missed patients. Each different surgeon who was on call had performed each experienced operation. These clinical outcomes were assessed: range of motion, grip strength, Mayo wrist score, and Disabilities of Arm, Shoulder, and Hand (DASH) score. For radiologic outcomes, the scapholunate angle, radiolunate angle, and lunotriquetral distance were measured. The total number of included patient was 20 (11 in group A and 9 in group O). Scaphoid union occurred in all patients except 1 individual (11 of 11 in group A, and 8 of 9 in group O). At the last follow-up, the mean flexion-extension arc was significantly greater in group A (125.0°) than in group O (105.6°) (P= .028). The mean grip strength was 81.1% that of the contralateral side in group A and 80.9% in group O (P= .594). The mean Mayo wrist score was 85.5 in group A and 79.4 in group O (P= .026), and the mean DASH score was 10.6 in group A and 20.8 in group O (P= .001); however, only the DASH score showed a minimum clinically important difference. The mean scapholunate angle, radiolunate angle, and lunotriquetral distance were similar between the 2 groups: 47.2°, 1.7°, and 2.0mm in group A and 48.8°, 5.6°, and 2.1mm in group O, respectively. Although both arthroscopic and open techniques achieved stability of the injured wrists in patients with trans-scaphoid PLFDs, it is shown that the arthroscopic-assisted technique showed a clinically meaningful better DASH score and greater flexion-extension arc with other parameters being similar. Level III, retrospective comparative study.

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

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.

Results of Perilunate Dislocations and Perilunate Fracture Dislocations With a Minimum 15-Year Follow-Up

To evaluate the long-term clinical, functional, and radiological outcomes in 30 patients with at least 15 years of follow-up. We performed a retrospective study that identified 73 patients. Thirty patients agreed to participate and were included. The mean follow-up was 18 years (range, 15-24 years). There were 14 cases of perilunate dislocation and 16 cases of perilunate fracture-dislocation (including 13 transscaphoid perilunate fracture-dislocations). At the last follow-up, the clinical and functional evaluation was based on the range of motion, grip strength, the Mayo wrist score, the Quick Disabilities of the Arm Shoulder and Hand score, and the Patient-Rated Wrist Evaluation score. Radiological abnormalities, according to the Herzberg classification, were 5 type A1 cases, 7 type B, 16 type B1, and 2 type C. The mean flexion-extension arc, radial-ulnar abduction arc, and pronation-supination arc were, respectively, 68%, 67%, and 80%, relative to the contralateral side. The mean grip strength was 70%, relative to the contralateral side. The mean Mayo wrist score was 70, and the mean Quick Disabilities of the Arm Shoulder and Hand and Patient-Rated Wrist Evaluation scores were, respectively, 20 and 21. Five patients had secondary procedure. Six patients had a complex regional pain syndrome type1. Although arthritis occurred in 70% of cases, its clinical and functional impact appeared to be low. However, the 2 lowest Mayo wrist scores corresponded to the patients with the most advanced arthritis. Complex regional pain syndrome appeared to have an impact on long-term outcomes. Therapeutic IV.

Bilateral Trans-Scaphoid Perilunate Fracture Dislocation

The wrist represents a complex anatomic region in the human extremity and a highly functional and intricate structural joint. Most perilunate injuries result from a staged disruption of the ligamentous structures. Forces may be directed through the carpal bones themselves resulting in a fracture. Early anatomic reduction of any carpal malalignment is of the utmost importance. Unfortunately, even with optimal treatment, outcomes after perilunate injuries are frequently poor. Generalized wrist stiffness, diminished grip strength, and post-traumatic arthritis commonly develop. Scaphoid fractures are frequent in everyday practice. But associated fractures of the scaphoid and capitate with 90�180�rotation of the head of the capitate are rare wrist injuries. This carpal bone injury has been defined by Fenton and Rosen since 1950. The Fenton syndrome should be recognized especially in great external force. The diagnosis of simultaneous scaphoid and capitate fractures at the time of Bilateral Trans-Scaphoid Perilunate Fracture Dislocation

Use of external fixation for perilunate dislocations and fracture dislocations.

The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation. Twenty patients (18 males and two females) with a mean age of 38 years (range 18–59) who had an acute dorsal perilunate dislocation or fracture dislocation were treated with the use of wrist external fixator and K-wires. The injuries included 12 perilunate dislocations, seven trans-scaphoid perilunate fracture dislocations, and one trans-styloid perilunate fracture dislocation. The median time from trauma to operation was 8 h (2–12 h). Indirect reduction via ligamentotaxis was achieved in all perilunate dislocation, and provisional K-wire fixation was added. In five of seven trans-scaphoid perilunate fracture dislocations, indirect reduction was achieved; whereas in the other two as well as in the case of trans-styloid perilunate fracture dislocation, open reduction was required. External fixator was supplemented with K-wires for stabilization of the fractures and the intercarpal intervals. The interosseous and capsular ligaments were not repaired, even after open reduction of fracture dislocations. The mean follow-up was 39 months (range 18–68 months). Range of motion and grip strength were measured. Cooney’s scoring system was used for the assessment of clinical function. Radiographic evaluation included time to scaphoid union, measurement of radiographic parameters (scapholunate gap, scapholunate angle, lunotriquetral gap, and carpal height ratio) and any development of arthritis. The flexion-extension motion arc and grip strength of the injured wrist averaged 80 and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney’s clinical scoring system, overall functional outcomes were rated as excellent in four patients, good in eight, fair in six, and poor in two. Eighteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid; one of them required scaphoid excision and midcarpal fusion. Two patients had radiographic evidence of arthritis. The use of external fixation and provisional K-wire fixation for the treatment of acute perilunate dislocations is associated with satisfactory midterm functional and radiographic outcomes. This minimally invasive treatment option is simple, reliable, and minimally invasive method that provides proper restoration and stable fixation of carpal alignment.

Vergleich der funktionellen Resultate mit MRT-Befunden nach operativer Versorgung von transskaphoidalen perilunären Luxationsfrakturen: Die Rolle von skapholunären Bandläsionen

The aim of this study was to review the outcome of transscaphoid perilunate fracture dislocations by MRI to use the advantages of MRI to show the post-traumatic degenerative changes, the examination of cartilage, the integrity of the ligaments and the vascularisation of the carpal bones. A second aim of this study is to interpret the findings in correlation to the functional results and the individual perception of hand functionality (PRWE). In this retrospective study, 20 patients (1 woman and 19 men), who were treated with open reduction and internal fixation at our institution, were reviewed at a mean of 67 (25-145) months postoperative. The mean age was 30 (12-73) years. The functional results were measured by range of motion (ROM), grip and pinch strength. The Mayo and Krimmer wrist scores were calculated and the SF-36 and the patient-rated wrist evaluation (PRWE) questionnaires were performed. Radiological findings included consolidation of the fracture and the radiological measures (revised carpal height, SL gap, SL and RL angle). An MRI, performed without a contrasting agent, was used to assess the degenerative changes of the joints, the vascularisation of the carpalia and the integrity of the SL ligament. Statistical data was calculated with SPSS. Range of motion and strength were reduced by 10-20% compared to the uninjured opposite side. Although the majority of the patients (85%) achieved good to very good results in the Mayo and Krimmer wrist scores, the MRI showed osteoarthritis in 95% of the cases in at least in 1 out of 5 patients evaluated intracarpal joints. MRI showed signs of complete SL ligament tears in 5 patients and a partial tear in 2 patients. The same group also showed the strongest degenerative changes. However, there was no correlation between patient satisfaction and imaging results. MRI findings, as well as X-ray findings, do not correlate with the subjective and objective functional outcomes after surgical treatment of transscaphoid perilunate fracture dislocations. It can be assumed that SL ligament lesions seen in MRI play a major role over the long term course.

Trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocations; surgical versus non surgical treatment.

Trans-scaphoid perilunate fracture-dislocation and perilunate dislocations are among uncommon injuries, most commonly seen in young patients due to high energy trauma. The treatment can be achieved either surgically by open reduction and internal fixation or closed reduction and casting. To compare surgical versus non-operative results of treatment after trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocation, we collected the data of 34 patients who were treated at least 5 years before our study, twenty of whom were treated surgically and fourteen were treated non-surgically. We compared clinical and radiological findings in two groups. Functional outcome was assessed by Mayo wrist score for each patient. The surgically treated patients had much higher Mayo wrist scores, 85 and 87.78 for perilunate dislocation and trans-scaphoid perilunate fracture-dislocation respectively, while 71 and 71.11 in non-surgically treated group respectively. Wrist range of motion was also more favorable in operative group (55 degrees flexion - 54 degrees extension for trans-scaphoid perilunate fracture-dislocation and 50 degrees flexion, 51 degrees extension for perilunate dislocations)than non-operative group(49 degrees flexion, 48 extension for trans-scaphoid fracture-dislocations and 48 degrees flexion, 50 degrees extension for perilunate dislocation). The radiographic changes showed arthritic changes but those changes did not significantly interfered with functional outcome and wrist scores. Regarding our better clinical results after early open reduction and internal fixation for these injuries, we can suggest the operative treatment of these complicated hand injuries.

Scaphoid malunion with 180° rotation of the proximal pole after treatment for trans-scaphoid perilunate fracture dislocation

Scaphoid malunion with 180° rotation of the proximal pole after treatment for trans-scaphoid perilunate fracture dislocation

A painful wrist after a fall on outstretched hand Trans-scaphoid perilunate fracture-dislocation

A painful wrist after a fall on outstretched hand Trans-scaphoid perilunate fracture-dislocation

Staged reduction of neglected transscaphoid perilunate fracture dislocation: A report of 16 cases

BackgroundTransscaphoid perilunate fracture dislocation is a rare injury and can be easily missed at the initial treatment. Once ignored, late reduction is not possible and needs extensive dissection. An alternative treatment such as proximal row carpectomy may be required for neglected injuries, but surgical outcome is not as good as that of an early reduction. We aim to present an alternative technique of staged reduction and fixation in patients of neglected transscaphoid perilunate dislocations and study its outcome.Material & Methods16 cases (14 males & 2 females) with neglected transscaphoid perilunate fracture dislocation (> 3 month old) were treated with staged reduction. Mean duration between injury and surgery was 4.5 months. In first stage an external fixator was applied across the wrist and distraction was done at 1 mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation.ResultsThe mean duration between two surgeries was 2.4 weeks (range 2–4 weeks). 9 cases had excellent results, 5 had good result. Two patients developed reflex sympathetic dystrophy and had fair results.ConclusionStaged reduction should be considered for neglected transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome.