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Perilunate Dislocations: Reduction and Stabilization.

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Summary

This study details an all-dorsal scapholunate reconstruction technique for stabilizing the scaphoid and lunate in reducible carpal injuries without arthrosis. It aims to restore wrist stability while preserving motion, though outcomes include reduced range of motion and strength.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Musculoskeletal Research

Background:

  • The all-dorsal scapholunate reconstruction technique is indicated for scapholunate injuries when the carpus is reducible and arthrosis is absent.
  • The primary goal is to reconstruct the dorsal scapholunate ligament to stabilize the scaphoid and lunate.

Purpose of the Study:

  • To describe the all-dorsal scapholunate reconstruction technique for treating scapholunate injuries.
  • To highlight the benefits of preserving native wrist motion compared to salvage procedures.

Main Methods:

  • A dorsal wrist approach is used, involving transposition of the extensor pollicis longus and retraction of extensor compartments.
  • A Berger ligament-sparing capsulotomy and extended open carpal tunnel release are performed for visualization and reduction.
  • Joystick pins are used for reduction, with suture tape securing the scaphoid and lunate after fixation with 4 pins. Kirschner wires (K-wires) are used for intercarpal fixation.

Main Results:

  • Outcomes vary, with a common decrease in wrist range of motion (55%-75% of contralateral) and grip strength (approx. 65%).
  • 50%-60% of laborers can return to full-time work. Disabilities of the Arm, Shoulder and Hand (DASH) scores average 24-30.
  • Risk factors for poor outcomes include delayed treatment, poor alignment, and open injuries.

Conclusions:

  • The all-dorsal technique offers scapholunate stabilization, preserving wrist motion, which is advantageous before arthrosis develops.
  • Patients should be counseled on potential permanent stiffness and the possibility of residual scapholunate diastasis.
  • Postoperative immobilization is maintained until pin removal at 3 months.