Treatment of perilunate and transscaphoid perilunate dislocations of the wrist

Abstract

Dorsal perilunate dislocations (PLDs) and dorsal transscaphoid perilunate dislocations (TS-PLDs) are reviewed in this paper, including the diagnosis, initial treatment, and options for definitive treatment. Closed reduction to obtain gross carpal alignment is performed on an urgent basis. Anatomic reduction is essential and is most consistently obtained by open-reduction, percutaneous pin fixation. A dorsal approach alone provides good visualization of the radiocarpal and midcarpal joints and allows efficient stabilization of dislocations and fracture-dislocations. To achieve stable fixation of the carpal bones, the senior author (JS) has developed a surgical technique that employs a specific order and configuration of Kirschner-wire placement. The stabilized joints parallel the major ligaments disrupted in PLD and TS-PLD: the volar radiocapitate, radiotriquetral, and radioscaphoid ligaments. Maintenance of stable anatomic reduction of the radiocarpal and midcarpal joints during healing is the key to satisfactory early and long-term clinical results.