Proximal row carpectomy versus open reduction and internal fixation in late-presenting perilunate dislocations

Area of Science:

• Orthopedic Surgery
• Hand Trauma
• Wrist Injuries

Background:

• Perilunate dislocations and fracture-dislocations are severe wrist injuries often resulting from high-energy trauma.
• Prompt treatment is crucial to prevent long-term complications, but optimal management for late presentations is debated.

Purpose of the Study:

• To compare the clinical outcomes of proximal row carpectomy (PRC) versus open reduction and internal fixation (ORIF) for late-presenting perilunate injuries.

Main Methods:

• Retrospective comparative study of 27 patients with perilunate injuries presenting >4 weeks post-injury.
• Patients underwent either PRC or ORIF.
• Outcomes assessed included DASH scores, VAS pain scores, range of motion, and grip strength at 3, 6, and 12 months post-operatively.

Main Results:

• Both PRC and ORIF significantly improved pain and function.
• At 3 months, PRC showed lower disability (DASH) and pain (VAS) scores than ORIF.
• At 12 months, outcomes were comparable, with PRC yielding greater wrist flexion and ORIF greater grip strength.

Conclusions:

• PRC is a viable option for late perilunate injuries, providing faster early recovery.
• PRC offers comparable long-term functional outcomes to ORIF.
• PRC demonstrates advantages in early pain relief and wrist flexion, while ORIF may yield superior grip strength.