[Perilunar dislocations and dislocation fractures in polytrauma patients--diagnosis and therapy]

Between 1978 and 1987 about 700 multiply injured patients were treated at the Department of Emergency Surgery (University Hospital Hamburg-Eppendorf). Seven of these suffered from injuries of the wrist, in detail six perilunar dislocations with fractures of the scaphoid and one dislocation of the triquetrum. In six cases the correct diagnosis was found primarily by clinical and X-ray examinations. The real extent of one patient's wrist injury was revealed by control radiograms which were taken twelve weeks after the accident, when the patient was transferred to our hospital. Follow-up examinations were made at an average of 40 months after the injury. We suggest the following procedure in cases of perilunar dislocations: 1. Early closed reduction and prolonged immobilization in casts. 2. In cases where closed reduction cannot be achieved open reduction, pinning (Kirschner-wires) and immobilization should be performed. 3. Fractures of the scaphoid are provided with screws.