Mid-long Term Results of Dorsal Approach and Temporary Fixation Procedure in Overlooked Perilunate Carpal Dislocation

Abstract

Aim:Our aim in this study is to present our mid-long term functional and radiological results after open reduction with dorsal approach, K-wire application and scapholunate ligament repair in cases with perilunate dislocation.Materials and Methods:Eleven patients who applied for perilunate dislocation between 2014 and 2018 and were followed up for at least 18 months were included in our study. The scapholunate angle, scapholunate gap, arthrosis, and avascular necrosis were evaluated in cases with isolated perilunate dislocations. The wrist flexion-extension and pronation-supination range of motion (ROM) of the patients were measured using a goniometer, and the wrist grip strength using a Jamar dynamometer. Functionally, the cases were evaluated according to the Disabilities of the Arm, Shoulder and Hand (DASH) scoring and the Herzberg clinical scoring system.Results:The mean age was 41.1 (28-64) years, the mean follow-up time was 3.8 (1.5-6) years. The mean scapholunate angle was 49.1±8.7 (37.3-70.4) degrees, the mean scapholunate gap was 2.0±0.5 (1.2-2.8) mm, the mean flexion-extension ROM was 131±17.5 (90-155) degrees, and the mean pronation-supination ROM was 155.4±6.1 (140-160) degrees. Patients had a mean DASH score of 5.6±3.2 (0-10.9) and a mean Herzberg clinical score of 89.1±9.4 (70-100).Conclusion:In perilunate dislocations, early and appropriate treatment is the main determinant of prognosis. Close follow-up of these injuries for at least 18 months is extremely important in terms of possible complications.

Keywords

• perilunate dislocation
• carpal instability
• arthrosis