Greater arch injuries.

Area of Science:

• Orthopedic Surgery
• Traumatology
• Hand Surgery

Background:

• Carpal bone dislocations and fracture dislocations are uncommon yet challenging injuries.
• Perilunate fracture dislocations involve significant ligamentous and osseous damage, often overlooked initially.
• Delayed diagnosis of these complex wrist injuries can lead to poor functional outcomes and early arthritis.

Purpose of the Study:

• To evaluate the management and outcomes of complex wrist injuries, including perilunate fracture dislocations and greater arch injuries.
• To highlight the challenges in diagnosing and treating these severe wrist traumas.
• To assess the effectiveness of various surgical interventions based on the Mayo wrist score.

Main Methods:

• A prospective study conducted from June 2008 to December 2013.
• Inclusion of 15 cases with complex wrist injuries: greater arch injuries, perilunate fracture dislocations, and dorsal scaphoid dislocation.
• Surgical interventions included open reduction and internal fixation, closed reduction with K-wire fixation, and proximal row carpectomy.

Main Results:

• Overall outcomes were 53% excellent, 33% good, and 14% fair according to the Mayo wrist score.
• Complications included Sudeck's osteodystrophy, scaphoid nonunion, and median nerve compression.
• Greater arch injuries require careful management due to multi-ligament involvement.

Conclusions:

• Prompt recognition of perilunate fracture dislocations and greater arch injuries is essential, often requiring CT and MRI.
• Management strategies should be tailored to the specific injury, involving reduction and fixation.
• Early and accurate diagnosis followed by appropriate surgical intervention can improve patient outcomes and prevent long-term disability.