Proximal row carpectomy for chronic unreduced perilunate dislocations

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Trauma Reconstruction

Background:

• Unreduced perilunate dislocations represent a significant challenge in wrist trauma management.
• Proximal row carpectomy (PRC) is a surgical option for complex wrist instabilities.
• Evaluating the long-term outcomes of PRC in this specific patient cohort is crucial.

Purpose of the Study:

• To assess the clinical and radiological outcomes of proximal row carpectomy (PRC) for unreduced perilunate dislocations.
• To investigate the correlation between radiological alignment and functional results after PRC.

Main Methods:

• Retrospective evaluation of 6 patients who underwent PRC for unreduced perilunate dislocation.
• Average follow-up period of 24 weeks from injury to surgery.
• Clinical assessment using the modified Mayo wrist score; radiological assessment of radius-capitate alignment.

Main Results:

• Pain resolved in 4 patients; mild residual pain during activity in 2.
• Average wrist range of motion (flexion-extension) was 59% of the contralateral side.
• Average grip strength was 72% of the unaffected side; average modified Mayo wrist score was 71.
• Three patients achieved favorable radius-capitate alignment, three had poor alignment.
• Poor alignment was associated with lower clinical scores, linked to preoperative capitate position.

Conclusions:

• Proximal row carpectomy (PRC) offers a viable treatment for unreduced perilunate dislocations, yielding pain relief and functional improvement.
• Postoperative radius-capitate alignment is a critical factor influencing clinical outcomes.
• Preoperative capitate positioning on lateral radiographs may predict postoperative alignment and functional results.