Perilunate dislocations treated with external fixation and percutaneous pinning

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Wrist Biomechanics

Background:

• Perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) are severe wrist injuries requiring effective treatment.
• Minimally invasive techniques are sought to improve outcomes and reduce complications.

Purpose of the Study:

• To evaluate clinical and radiographic outcomes of PLDs and PLFDs treated with external fixation and Kirschner wires (K-wires).

Main Methods:

• Twenty patients with acute PLD or PLFD underwent treatment with external fixators and K-wires.
• Indirect reduction via ligamentotaxis was attempted in 17 patients; open reduction was necessary in three cases.
• Intercarpal ligaments were not repaired surgically, even after open reduction.

Main Results:

• Mean follow-up was 39 months, with average flexion-extension ROM and grip strength at 80% and 88% of the contralateral wrist, respectively.
• Functional outcomes were rated excellent (4), good (8), fair (4), and poor (1) using Cooney's scoring system.
• Two patients developed scaphoid nonunion, and two developed posttraumatic arthritis; 15 patients returned to their previous occupations.

Conclusions:

• External fixation with percutaneous K-wires provides satisfactory midterm functional and radiographic outcomes for acute PLDs.
• This technique is simple, minimally invasive, restores carpal alignment, and may be advantageous in polytrauma patients due to reduced operative time and blood loss.
• Open reduction may be necessary for complex PLDs/PLFDs, particularly with polytrauma or scaphoid comminution.