Perilunate Dislocation Reduction Technique and Results

Perilunate dislocations are severe upper extremity dislocations to the wrist involving ligamentous injury. Previous literature cites closed reduction of perilunate injuries at 25%. Herein, the technique and results of closed reductions for perilunate dislocations are described.

Chart reviews were conducted of perilunate injuries treated from 2017 to 2022. Imaging was evaluated to categorize by Herzberg stage. Reduction was performed in the emergency department (ED) and involved traction, relaxation, and manipulation. Reduction attempts and success rates were recorded as were presence and resolution of median nerve symptoms.

Fifty-six perilunate injuries were included with an average age of 36 years. Forty-five (80%) underwent attempted closed reduction, of which 37 (82%) were successful. Twenty-seven (48%) were Herzberg I, 18 (32%) were Herzberg IIA, and 11 (20%) were Herzberg IIB. Two Herzberg IIB injuries were mal-reduced, with the lunate returned to the lunate fossa inverted. Scaphoid fractures were more likely in Herzberg I injuries and did not influence the success of reduction. Thirty (54%) patients presented with median nerve symptoms, of which 25 underwent attempted closed reduction in ED. Perilunate reduction resolved nerve symptoms in 92% of cases. Nerve symptoms were not more common in Herzberg II perilunate injuries. Successful closed reduction of perilunate injuries was not associated with a specific Herzberg stage.

Closed perilunate reductions in the ED can have a high success rate >80%. Herzberg II perilunate injuries have >70% (76%) success rate in closed reduction. Rates of median nerve symptoms were high and resolved in most cases (92%) after reduction. Closed reduction of perilunate injuries can safely be attempted in the ED and resolves nerve compression prior to surgery.