Perilunate injuries. Repair by dual dorsal and volar approaches

Controversy persists regarding optimal management of perilunate injuries. Traditionally, closed treatment, with or without percutaneous pin fixation, was advocated for these highly unstable carpal disruptions, but the inconsistent and often disappointing outcome of closed reduction, coupled with the recognition that functional recovery closely parallels the accuracy of restoring carpal alignment, have led to increasing enthusiasm for open treatment. The favorable outcome reported in this article supports both the contention that the acute perilunate injury affords the opportune time for operative preservation of carpal stability and the efficacy of the combined dorsal and volar approaches as the optimal means of surgical repair. This clinical experience also corroborates experimental evidence that perilunate injuries are apt to cause a predictable spectrum of osseous and soft tissue lesions--lesions usually suitable for early, precise repair. For the skilled athlete, prompt recognition and precision treatment of all components of injury are the critical factors to attain a functional outcome commensurate with a successful return to competition.