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

Document Type : RESEARCH PAPER


1 Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Orthopedic Surgery, Guilan University of Medical Sciences, Rasht, Iran

3 Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Level of evidence: II


1. Bain GI, Pallapati S, Eng K. Translunate perilunate
injuries—a spectrum of this uncommon injury.
Journal of wrist surgery. 2013; 2(1):63.
2. Herzberg G, Forissier D. Acute dorsal trans-scaphoid
perilunate fracture-dislocations: medium-term results.
Journal of Hand Surgery. 2002; 27(6):498-502.
3. Sauder DJ, Athwal GS, Faber KJ, Roth JH. Perilunate
injuries. Orthopedic Clinics of North America. 2007;
4. Kremer T, Wendt M, Riedel K, Sauerbier M, Germann
G, Bickert B. Open reduction for perilunate injuries—
clinical outcome and patient satisfaction. The Journal
of hand surgery. 2010; 35(10):1599-606.
5. Cheung JP, Tang CY, Fung BK. Current management of
acute scaphoid fractures: a review. Hong Kong Med J.
2014; 20(1):52-8.
6. Knoll VD, Allan C, Trumble TE. Trans-scaphoid
perilunate fracture dislocations: results of screw 
fixation of the scaphoid and lunotriquetral repair
with a dorsal approach. The Journal of hand surgery.
2005; 30(6):1145-e1.
7. Polsky MB, Kozin SH, Porter ST, Thoder JJ. Scaphoid
fractures: dorsal versus volar approach. Orthopedics.
2002; 25(8):817-9.
8. Lutz M, Arora R, Kammerlander C, Gabl M, Pechlaner
S. Stabilization of perilunate and transscaphoid
perilunate fracture-dislocations via a combined
palmar and dorsal approach. Operative Orthopadie
und Traumatologie. 2009; 21(4-5):442-58.
9. Wong TC, Ip FK. Minimally invasive management
of trans-scaphoid perilunate fracture-dislocations.
Hand Surgery. 2008; 13(03):159-65.
10. Jeon IH, Kim HJ, Min WK, Cho HS, Kim PT.
arthroscopically assisted percutaneous fixation
for trans-scaphoid perilunate fracture dislocation.
Journal of Hand Surgery (European Volume). 2010;
11. Bushnell BD, McWilliams AD, Messer TM.
Complications in dorsal percutaneous cannulated
screw fixation of nondisplaced scaphoid waist
fractures. The Journal of hand surgery. 2007;
12. Wu WC. Percutaneous cannulated screw fixation
of acute scaphoid fractures. Hand Surgery. 2002;
13. Herzberg G, Comtet JJ, Linscheid RL, Amadio PC,
Cooney WP, Stalder J. Perilunate dislocations and
fracture-dislocations: a multicenter study. The Journal
of hand surgery. 1993; 18(5):768-79.
14. Angst F, Schwyzer HK, Aeschlimann A, Simmen
BR, Goldhahn J. Measures of adult shoulder
function: Disabilities of the arm, shoulder, and
hand questionnaire (DASH) and its short version
(QuickDASH), shoulder pain and disability index
(SPADI), American Shoulder and Elbow Surgeons
(ASES) Society standardized shoulder assessment
form, constant (Murley) score (CS), simple shoulder
test (SST), Oxford shoulder score (OSS), shoulder
disability questionnaire (SDQ), and Western ontario
shoulder instability index (WOSI). Arthritis care &
research. 2011; 63:S174.
15. Stanbury SJ, Elfar JC. Perilunate dislocation and
perilunate fracture-dislocation. JAAOS-Journal of the
American Academy of Orthopaedic Surgeons. 2011;
16. Souer JS, Rutgers M, Andermahr J, Jupiter JB, Ring
D. Perilunate fracture–dislocations of the wrist:
comparison of temporary screw versus k-wire fixation.
The Journal of hand surgery. 2007; 32(3):318-25.
17. Komurcu M, Kürklü M, Ozturan KE, Mahirogullari M,
Basbozkurt M. Early and delayed treatment of dorsal
transscaphoid perilunate fracture-dislocations. Journal
of orthopaedic trauma. 2008; 22(8):535-40.
18. Park MJ, Ahn JH. Arthroscopically assisted reduction
and percutaneous fixation of dorsal perilunate
dislocations and fracture-dislocations. Arthroscopy:
The Journal of Arthroscopic & Related Surgery. 2005;
19. Adkison JW, Chapman MW. Treatment of acute lunate
and perilunate dislocations. Clinical orthopaedics and
related research. 1982 (164):199-207.
20. Papadonikolakis A, Mavrodontidis AN, Zalavras C,
Hantes M, Soucacos PN. Transscaphoid volar lunate
dislocation: a case report. JBJS. 2003; 85(9):1805-8.
21. Malović M, Pavić R, Milošević M. Treatment of
trans-scaphoid perilunate dislocations using a
volar approach with scaphoid osteosynthesis and
temporary Kirschner wire fixation. Military medicine.
2011; 176(9):1077-82.
22. Virani SR, Wajekar S, Mohan H, Dahapute AA. A unique
case of bilateral trans-scaphoid perilunate dislocation
with dislocation of lunate into the forearm. Journal of
clinical orthopaedics and trauma. 2016; 7:110-4.
23. Yildirim C, Unuvar F, Keklikci K, Demirtas M.
Bilateral dorsal trans-scaphoid perilunate fracture–
dislocation: A case report. International journal of
surgery case reports. 2014; 5(5):226-30.
24. Amouzadeh Omrani, F., Khak, M., Sarzaeem, M.,
Kazemian, G. Arthroscopic Fixation of Traumatic
Tibial Bone Avulsion of Posterior Cruciate Ligament
Using Scorpion Suture Passer: A New Technique.
Trauma Monthly. 2018; 23(3).
Volume 8, Issue 5
September 2020
Pages 633-640
  • Receive Date: 15 September 2019
  • Revise Date: 06 May 2020
  • Accept Date: 09 May 2020
  • First Publish Date: 01 September 2020