Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases

Abstract

27 patients (28 cases), were treated for perilunate dislocations in 20 and fracture-dislocations in 8. Capitate displacement was dorsal in 27 cases and palmar in 1 case, and in 16, the scaphoid was fractured. There was no substantial delay of treatment. In 8 patients treated with closed reduction, follow-up averaged 6 (1-15) years. 19 patients (20 cases) who underwent early open reduction with K-wire stabilization and ligamentous repair, had an average follow-up of 2 (0.5-7) years. The clinical outcome was evaluated using a scoring system based on pain, occupation, ROM and grip strength, while the radiographic outcome was assessed according to findings of carpal instability, nonunion of scaphoid, and/or arthrotic changes. In patients treated with closed reduction, results were fair in 3 and poor in 5, while patients treated with early open reduction had a better clinical score with 4 excellent, 9 good, 3 fair and 4 poor results. These findings suggest that perilunate fracture-dislocations are too unstable to be treated with closed reduction. In addition, a combined approach was found effective in the management of dorsal perilunate dislocations. Finally, open reduction presupposes reparation of the torn scapholunate ligament, to obtain normal carpal kinematics.