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Current Perspectives on Complex Wrist Fracture-Dislocations.

Jesse B Jupiter1, Fiesky A Nunez, Fiesky Nunez

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Perilunate injuries are severe wrist injuries often missed on initial diagnosis. Prompt recognition and surgical treatment are crucial for optimal patient outcomes and to prevent long-term complications.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Hand Surgery

Background:

  • Perilunate injuries, though rare (5% of carpal injuries), are complex and result from high-energy trauma.
  • Missed diagnosis occurs in 25% of patients, delaying critical treatment and potentially worsening outcomes.
  • Associated injuries include fractures, dislocations, and ligament damage, alongside risks of median nerve compromise.

Purpose of the Study:

  • To emphasize the critical need for immediate diagnosis of perilunate injuries.
  • To outline the management pathway, including closed and open reduction techniques.
  • To discuss potential complications and the importance of timely surgical intervention for satisfactory outcomes.

Main Methods:

  • Diagnosis relies on radiographic assessment.
  • Initial management involves closed reduction to protect neurovascular structures.
  • Definitive treatment includes open reduction, anatomic alignment, stable fixation, and ligament repair.

Main Results:

  • Prompt diagnosis and surgical management are key to achieving satisfactory outcomes in perilunate injuries.
  • Despite optimal treatment, complications such as median nerve dysfunction, carpal instability, and arthritis can occur.
  • Radiographic arthritis may not correlate with functional deficits, and salvage procedures may be needed for persistent issues.

Conclusions:

  • Timely recognition and surgical intervention are paramount for managing perilunate injuries and mitigating complications.
  • While surgical repair aims to restore function, long-term complications necessitate ongoing monitoring and potential further intervention.
  • Radiocarpal fracture-dislocations share similar high-energy mechanisms and complication profiles, underscoring the severity of these wrist injuries.