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Outcomes of acute perilunate injuries—a systematic review

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Abstract

Purpose

The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date.

Material and methods

This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included.

Results

Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6–7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2–1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1–0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable.

Conclusions

Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare.

Level of evidence: Systematic review of level IV studies.

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Data availability

The raw and metadata of this systematic literature review are on file with the corresponding author and can be made available upon request.

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Authors and Affiliations

  1. Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland

    Rémy Liechti, Dominique Nellie Merky, Adriaan Ockert Grobbelaar, Esther Vögelin & Stefanie Hirsiger

  2. Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland

    Bryan J. M. van de Wall

  3. Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Bryan J. M. van de Wall

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  1. Rémy Liechti
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Contributions

All listed authors have made substantial contributions to this article. The design and conception of the work, analysis, and interpretation of data was carried out by RL, DNM and SH. RL wrote the first draft of the manuscript. Critical revision for important intellectual content as well as final approval of the version to be published was done by AOG, BJMVDW and EV. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Liechti, R., Merky, D.N., Grobbelaar, A.O. et al. Outcomes of acute perilunate injuries—a systematic review. Eur J Trauma Emerg Surg 49, 2071–2084 (2023). https://doi.org/10.1007/s00068-023-02222-y

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