Treatment of chronic perilunate dislocations

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Trauma Care

Background:

• Perilunate dislocations are complex wrist injuries often involving significant ligamentous disruption.
• Delayed treatment of perilunate dislocations can lead to chronic pain, stiffness, and functional deficits.
• Optimal management strategies for chronic, untreated perilunate dislocations remain debated.

Purpose of the Study:

• To evaluate the long-term outcomes of surgically treated, chronic perilunate dislocations.
• To compare the efficacy of different surgical interventions for untreated perilunate dislocations.

Main Methods:

• Retrospective review of 15 patients with 16 perilunate dislocations untreated for at least 6 weeks.
• Mean follow-up of 6.4 years, with a median treatment delay of 17 weeks.
• Surgical interventions included open reduction and internal fixation, carpal bone excision, wrist arthrodesis, proximal row carpectomy, and carpal tunnel release.

Main Results:

• Isolated carpal bone excision (lunate or scaphoid) yielded uniformly poor results.
• Wrist arthrodesis and proximal row carpectomy had complications, including pseudarthrosis and need for secondary surgery.
• All six patients treated with open reduction and internal fixation achieved satisfactory outcomes without further procedures.

Conclusions:

• Open reduction and internal fixation is a reliable and effective treatment for chronic perilunate dislocations.
• Surgical options like isolated carpal bone excision, wrist arthrodesis, and proximal row carpectomy are associated with poorer outcomes in this patient cohort.
• Early definitive treatment is crucial for optimizing outcomes in perilunate dislocations.