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. 2021 Oct 5;11(2):164-176.
doi: 10.1055/s-0041-1735841. eCollection 2022 Apr.

Perilunate Injury Timing and Treatment Options: A Systematic Review

Mark J W van der Oest  1 , Liron S Duraku  1 , Madina Artan  1 , Caroline A Hundepool  1 , Dominic M Power  2 , Vaikunthan Rajaratnam  3 , J Michiel Zuidam  1
Affiliations

Perilunate Injury Timing and Treatment Options: A Systematic Review

Mark J W van der Oest et al. J Wrist Surg. .

Abstract

Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.

Keywords: ORIF; Perilunate injuries; surgical treatment; time frame.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Mayfield classification of carpal instability describes the progressive ligamentous injury around the lunate. Stage I: scapholunate dissociation; stage II: I + lunocapitate disruption; stage III: II + lunotriquetral disruption, also referred as perilunate; stage IV: lunate dislocation, frequently volar, which results in median nerve compression.
Fig. 2
Fig. 2
Trauma mechanism of a perilunate injury with only ligamentous injury; the lesser arc of perilunate dislocation (PLD) and a luxation with one of more fractures; the greater arc injury or perilunate fracture dislocation (PLFD).
Fig. 3
Fig. 3
Flow diagram. This diagram shows the flow of studies in this review and the reasons why they were excluded. Image courtesy: Moher et al.
See this image and copyright information in PMC

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