Abstract
Background Perilunate dislocations and perilunate fracture dislocations (PLDs/PLFDs) are rare
and often associated with poor outcomes. Heretofore, these outcomes have not been
evaluated in a high-demand military population.
Questions/Purpose The purpose of this study was to evaluate the outcomes in a young, active population
after sustaining PLD/PLFD injuries.
Patients and Methods We retrospectively reviewed the U.S. military service members who underwent surgical
treatment for a PLD/PLFD (Current Procedural Terminology codes 25695 and 25685) between
June 1, 2010, and June 1, 2014 through the Military Health System Management Analysis
and Reporting Tool (M2) database, capturing patients with a minimum 2-year follow-up.
Patient characteristics and outcomes were gathered; however, radiographic analysis
was not possible.
Results In this study, 40 patients (40 wrists) were included with an average follow-up of
47.8 months. The average age was 28.8 years. Twenty-two injuries (55%) were PLFD and
22 (55%) cases involved the nondominant extremity. On initial presentation, 11 (27.5%)
were missed and 50% of patients were presented with acute carpal tunnel syndrome.
Range of motion (ROM) was 74% and grip strength was 65% compared with the contralateral
wrist; 78% reported pain with activity and only 55% remained on active duty status
at final follow-up. Injuries to the nondominant extremity were significantly more
likely to experience a good to excellent outcome and regained a more ROM. Patients
with ligamentous PLD had less pain at rest and were more likely to return to sport.
Conclusion Worse outcomes can be expected for PLD/PLFD of the dominant extremity, transscaphoid
PLFD, greater arc injuries, and those undergoing pinning alone. A high-demand patient
may expect worse functional results with a higher degree of limitation postoperatively.
Level of Evidence The level of evidence is therapeutic IV.
Keywords
perilunate dislocation - greater arc - lesser arc - wrist
