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Less is More in Acute Perilunate Injuries? Early Success with Arthroscopic-Assisted Fixation of The Proximal Row
Jonathan Persitz1, Anne Doi2, Sam Keshen2
1Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, University Health Network, Department of Surgery, Affiliated With Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, Affiliated With Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Purpose:
To evaluate the short-term safety and clinical effectiveness of arthroscopic-assisted reduction with percutaneous proximal-row stabilization performed without intrinsic ligament repair for acute perilunate injuries.
Methods:
Patients with acute, isolated perilunate injuries treated by a single surgeon between 2021 and 2025 were prospectively enrolled. All underwent arthroscopic-assisted reduction and percutaneous proximal-row stabilization without intrinsic ligament repair. Clinical evaluation included objective functional assessment and patient-reported outcome measures. Radiographic analysis included measurement of the scapholunate interval, scapholunate, radiolunate and radioscaphoid angles, dorsal scaphoid translation, fracture union, and presence of degenerative changes.
Results:
Ten male patients (36 ± 14 years) were treated at a mean of 5 ± 3 days post-injury; 40% presented with median neuropathy. Eight injuries were Mayfield stage III and two stage IV, with five fracture-dislocation patterns. At a mean 14-month follow-up, patients demonstrated favorable early outcomes (Disabilities of the Arm, Shoulder and Hand score 7 ± 10, Modified Mayo Wrist Score 89 ± 7, Patient-Rated Wrist Evaluation 14.6 ± 15.1, and Visual Analog Scale pain score 0.4 ± 1), near-symmetric motion and grip strength, and maintained radiographic alignment (mean scapholunate gap 2.3 ± 0.8 mm). All fractures united, there were no post-operative complications, and all manual laborers returned to unrestricted work at 28 ± 16 weeks.
Conclusion:
Arthroscopic-assisted reduction and percutaneous proximal-row fixation without ligament repair appears feasible and safe, yielding excellent short-term functional and radiographic outcomes with minimal morbidity. Larger studies with longer follow-up are needed to determine long-term durability.
Prospective Case Series:
Level IV.
