Functional Outcome of Surgically Managed Perilunate Injuries
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ORIGINAL ARTICLE
Functional Outcome of Surgically Managed Perilunate Injuries Joseph George1 · Kannan Karuppiah Kumar1 · Girish Vijayakumar1 · Muniramaiah Ravishankar1 Received: 2 May 2020 / Accepted: 3 August 2020 © Indian Orthopaedics Association 2020
Abstract Background Perilunate injuries are rare and quite often missed. We present our experience and outcomes, surgically managing these difficult injuries. Methods We analysed data from 14 patients who underwent open reduction and internal fixation of perilunate injuries. All patients underwent open reduction and fixation through the dorsal approach. Fractures were fixed with either K-wires or Headless compression screws. At regular intervals radiographs, range of motion, grip strength, modified Mayo score, Quick DASH score and Lyon wrist scores were collected. Results The average age of our patients was 29.2. Average time to surgical intervention was 11.3 days. The mean follow-up period was 42.3 months. modified Mayo wrist score, QuickDASH score and Lyon wrist scores were 77.86, 1.62 and 80.86, respectively. Wrist flexion/extension arc was 101.43. Wrist radial/ulnar deviation was 50.0. Mean grip strength was 69.93% of the opposite side. Radiological evidence of wrist arthritis and lunate avascular necrosis was seen in 8 (57.14%) and 4 (28.6%) cases, respectively. Conclusion Early open reduction of perilunate injuries gives reliable results, in spite of radiological evidence of wrist arthritis in a majority of the cases. Keywords Perilunate injuries · Perilunate dislocations · Perilunate fracture dislocations · Trans-scaphoid perilunate dislocation · Lunate dislocation
Introduction Perilunate injuries are relatively rare injuries accounting for 7% of all injuries of the carpus [1, 2]. This injury often results from high-energy trauma including motor vehicle accidents, fall from height or contact sports. Early diagnosis and treatment of these injuries are essential to restore wrist motion and function and to avoid chronic carpal instability or arthritis [3, 4]. Perilunate dislocations and fracture–dislocations are a subcategory of the carpal instability complex. The impact of the trauma can propagate through ligaments (perilunate dislocations) and/or bone (fracture–dislocations), creating multiple variations of a basic injury pattern [5]. The typical presentation of an acute perilunate dislocation includes pain and swelling about the wrist. Deformity may be more subtle than expected and this injury can be missed frequently. The * Kannan Karuppiah Kumar [email protected] 1
Hosmat hospital, Bangalore, India
carpus is usually displaced dorsally. In a lunate dislocation, the lunate can come to lie within the carpal tunnel; therefore, a thorough neurovascular assessment of the upper extremity is important. PA, lateral, and oblique radiographs are the key to the diagnosis. The PA view shows disruption of the normal carpal arcs, i.e., two breaks in Gilula’s arcs. The lateral radiograph reveals loss of co-linearity between the capitate, lunate, and the radi
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