Outcomes after Acute Perilunate Injuries: A Single-Center Experience Over 30 Years

Perilunate fracture-dislocations represent a spectrum of devastating wrist injuries. They typically involve high-energy mechanisms, occur in young patients and are relatively uncommon. Our current knowledge on this rare wrist pathology is limited as most studies involve small retrospective case series and limited follow-up.

The purpose of this study was to examine the functional, radiographic, and patient reported outcomes after perilunate injuries and evaluate surgical practice trends over time.

A retrospective review identified 123 patients who had open reduction and internal fixation of an acute perilunate injury at a single academic centre over a 30-year study period. Post-operative functional, patient-reported, and radiographic outcomes were assessed. The association of various surgical and injury-related variables on outcomes was examined using independent t -tests and ANOVA testing, with post-hoc analysis. Significance was set at p  < 0.05.

Fourty-seven patients participated with a mean follow-up of 14 years. All patients underwent urgent or semi-urgent operative intervention with a dorsal or combined approach. At final follow-up, mean patient-rated wrist evaluation score was 24.2, visual analogue scale pain score was 2.4, flexion-extension arc was 56% of the contralateral side and grip strength was 76%. Patients who underwent re-operation or injured their dominant hand had worse outcomes. Only 9% of patients were unable to return to their same job or a similar job as a result of their injury.

Overall, patients retain a relatively high level of function and report low pain scores long-term after perilunate injuries. Multi-centre, prospective studies are required going forward.