Trans-Scaphoid Perilunate Fracture-Dislocation and Isolated Perilunate Dislocations; Surgical Versus Non Surgical Treatment

Document Type: RESEARCH PAPER

Authors

1 Orthopedic Research Center, Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran.

2 Orthopedic Research Center, Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

 
Background: 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 reduc
tion and internal fixation or closed reduction and casting.
 
Methods:
To compare surgical versus non-operative results of treatment of 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 nonsurgical. We compared clinical and radiological findings in two groups. Functional outcome was assessed by Mayo wrist score for each patient.
Results:
The surgically treated patients had much higher Mayo wrist scores, 85 and 87.78 for perilunate dislocation and trans-scaphoid 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 flexion - 54.28 extension for trans-scaphoid fracture-dislocations and 50 flexion, 51.66 extension for perilunate dislocations)than non-operative group(48.5 flexion, 48.1 extension for trans-scaphoid fracture-dislocations and 48.1 flexion, 50 extension for perilunate dislocation). The radiographic changes showed arthritic changes but those changes did not significantly interfered with functional outcome and wrist scores.
Conclusion:
Regarding our better clinical results after early open reduction and internal fixation for these injuries, we can suggest the operativetreatment of these complicated hand injuries.

Keywords


Apergis E, Maris J, Theodoratos G, Pavlakis D, Antoniou N. Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases. Acta Orthop Scand Suppl. 1997; 275:55-9.

  • Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am. 1993; 18(5): 768-79.

  • Su CJ, Chang MC, Liu Y, Lo WH. Lunate and perilunate dislocation. Zhonghua Yi Xue Za Zhi. 1996; 58:348-54.

  • Adkison JW, Chapman MW. Treatment of acute lunate and perilunate dislocations. Clin Orthop Relat Res. 1982; 164:199-207.

  • Martinage A, Balaguer T, Chignon-Sicard B, Moteil MC, Dreant N, Leberton E. Perilunate dislocations and fractue-dislocations of the wrist, a review of 14 cases [in French]. Chir Main. 2008; 27:31-9.

  • Cooney WP, Bussey R, Dobyns JH, Llinsch RL. Difficult wrist fractures. Perilunate fractue-dislocations of the wrist. Clin Orthop Relat Res. 1987; 214: 136-47.

  • Massoud AH, NaamNH. Functional outcome of open reduction of chronic perilunate injuries. J Hand Surg Am. 2012; 37(9): 1852-60.

  • Garg B, Goyal T, Kotwal PP. Staged reduction of neglected transscaphoid perilunate fracture dislocation. a report of 16 cases. J Orthop Surg Res. 2012;7:19.

  • Altissimi M, Mancici GB, Azzara A. Perilunate dislocations of the carpus: A long-term review. Italy J OrthopTraumatol. 1987; 13:491-500.

  • Pai CH, Wei DC, Hu ST. Carpal bone dislocations: an analysis of twenty cases with relative emphasis on the role of crushing mechanisms. J Trauma. 1993; 35:28-35.

  • Herzberg G, Forissier D. Acute dorsal trans-scaphoid fractue-dislocations: medium-term results. J Hand Surg Br. 2002;27(6):498-502.

  • Komurku M, Kurklu M, Ozturan KE, Mahirogullari M, Basbozhurt M. Early and delayed treatment of doral transscaphoid perilunate fracture-dislocations. J Orthop Trauma. 2008; 22:535-40.

  • Souer JS, Rutgers M, Andermahr J, Jupiter JB, Ring D. Perilunate fractue-dislocations of the wrist: comparison of temporary screw versus K-wire fixation. J Hand Surg Am. 2007; 32(3):318-25.

  • Knoll VD, Allan C, Trunble TE. Transscaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid one lunotriquetral repair with a dorsal approach. J Hand Surg Am. 2005; 30(6):1145-52.

  • Hildebrand KA, Ross DC, Patterson SD, Roth JH, MacDermid JC, King GJ. Dorsal perilunate dislocations and fractue-dislocations: questionnaire, clinical, and radiographic evaluation. J Hand Surg Am. 2000; 25(6): 1069-79.

  • Sotereanos DG, Mitsionis GJ, Giannakopoulos PN, Tomaino MM, Herndon JH. Perilunate dislocation and fractue-dislocation: a critical analysis of the volar-dorsal approach. J Hand Surg Am. 1997; 22(1):49-54.