Treatment of Perilunate Injuries With Radial-sided Fixation

Perilunate dislocations and fracture-dislocations are high-energy wrist injuries. Standard treatment involves urgent closed reduction followed by open reduction and fixation of both radial (scapholunate) and ulnar (lunotriquetral) intervals. In our experience, fixation of the radial-sided injury alone (scaphoid fracture or scapholunate ligament tear) restores carpal alignment without separate lunotriquetral stabilization. We present the largest series to date using this approach.

Between 2004 and 2025, 36 patients with acute perilunate injuries were treated by a single surgeon with a radial-sided only fixation protocol. All underwent urgent closed reduction, followed by Kirschner wire fixation for ligamentous injuries or headless compression screw fixation for scaphoid waist fractures. Patients were immobilized in a short arm cast for 8 weeks, with wires removed at that time. Radiographs obtained postoperatively and at final follow-up were assessed for scapholunate angle, scapholunate and lunotriquetral intervals, and presence of volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) deformity.

All patients achieved stable carpal alignment with radial-sided only fixation. At final follow-up, mean scapholunate angle was 55° (range 34°-84°), mean scapholunate interval 1.8 mm, and mean lunotriquetral interval 1.7 mm. No patients developed VISI deformity.

Perilunate injuries can be effectively managed with fixation limited to the radial side, eliminating the need for lunotriquetral pinning. This series-the largest reported with this technique-challenges traditional dogma derived from Mayfield's description and demonstrates excellent radiographic outcomes with a simplified surgical approach.