Treatment of dorsal perilunate dislocations and fracture-dislocations using a standardized protocol.
Publication/Presentation Date
12-1-2012
Abstract
BACKGROUND: The aims of this study were to evaluate the associated injuries occurring with acute perilunate instability and to assess the clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with a combined dorsal and volar approach.
METHODS: A total of 45 patients (46 wrist injuries) with perilunate dislocations and fracture-dislocations were prospectively evaluated. The size of the mid-carpal ligament tear, the location of the scapholunate ligament tear, and the presence of osteochondral fragments and of the dorsal radiocarpal ligament avulsions were recorded at injury. Final clinical and radiographic outcomes were evaluated in 25 cases (25 wrists) with a minimum of 6 months of follow-up.
RESULTS: Intraoperative examination of the 46 cases with operative treatment showed the volar carpal ligament tear to be present 100 % of the time and to be an average length of 3.4 cm. Complete avulsion of the dorsal extrinsic radiocarpal ligaments was found in 65.2 % of cases. The scapholunate ligament was torn in 35 cases. Osteochondral fragments were found either volarly or dorsally in 74 % of the cases. The average flexion-extension arc was 82°, forearm rotation was 155°, and grip strength averaged 59 % of the uninjured hand. The average final scapholunate angle was 55° and the scapholunate gap was 2.2 mm.
CONCLUSION: Treatment of perilunate fracture-dislocations with a combined volar and dorsal approach results in reasonable and functional clinical results. The incidence of associated injuries with these carpal dislocations is high. Although the perilunate fracture-dislocations have a slightly better radiologic alignment than the dislocation group, the clinical outcome is similar.
Volume
7
Issue
4
First Page
380
Last Page
387
ISSN
1558-9447
Published In/Presented At
Capo, J. T., Corti, S. J., Shamian, B., Nourbakhsh, A., Tan, V., Kaushal, N., & Debkowska, M. (2012). Treatment of dorsal perilunate dislocations and fracture-dislocations using a standardized protocol. Hand (New York, N.Y.), 7(4), 380–387. https://doi.org/10.1007/s11552-012-9452-y
Disciplines
Medicine and Health Sciences
PubMedID
24294157
Department(s)
Department of Medicine
Document Type
Article