The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Farshid Bagheri
Mohhamad H Taraz Jamshidi
Ali Birjandinejad
Seyyed Reza Sharifi Daloei
Masoud Mirkazemi
Meysam Fathi Choghadeh
Maryam Asadian
Hasan Rahimi Shorin
Orthopedic Research Center, Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/abjs.2013.2089
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
Hand surgery
Non-operative treatment
Open reduction and internal fixation
Perilunate Dislocations
Trans-scaphoid fracture-dislocation

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The Archives of Bone and Joint Surgery
Volume 1, Issue 2 - Serial Number 2
December 2013
Pages 74-77

  • Receive Date 30 August 2013
  • Revise Date 05 October 2013
  • Accept Date 01 December 2013