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Treatment of dorsal perilunate dislocations and fracture–dislocations using a standardized protocol

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HAND

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.

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Conflict of Interest

The authors declare that they have no conflicts of interest, commercial associations, or intent of financial gain regarding this research.

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Authors and Affiliations

  1. Department of Orthopaedics, Division of Hand and Microvascular Surgery, UMDNJ—New Jersey Medical School, 90 Bergen Street, DOC 1200, Newark, NJ, USA

    Sandro J. Corti, Ben Shamian, Ali Nourbakhsh, Virak Tan, Neil Kaushal & Monika Debkowska

  2. Department of Orthopaedics, NYU Medical Center–Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA

    John T. Capo

Authors
  1. John T. Capo
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  2. Sandro J. Corti
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  3. Ben Shamian
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  4. Ali Nourbakhsh
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  5. Virak Tan
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  6. Neil Kaushal
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  7. Monika Debkowska
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Correspondence to John T. Capo.

Additional information

Type of the study and the level of evidence: Prospective, Level II

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Capo, J.T., Corti, S.J., Shamian, B. et al. Treatment of dorsal perilunate dislocations and fracture–dislocations using a standardized protocol. HAND 7, 380–387 (2012). https://doi.org/10.1007/s11552-012-9452-y

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  • DOI: https://doi.org/10.1007/s11552-012-9452-y

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