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J Wrist Surg 2015; 04(02): 081-087
DOI: 10.1055/s-0035-1550160
Special Focus Section: Perilunate Injuries
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Treatment of Perilunate Dislocations and Fracture Dislocations

Jong Pil Kim
1   Department of Orthopedic Surgery, College of Medicine, Graduate School of Dankook University, Cheonan, Korea
2   Department of Kinesiology and Medical Science, Graduate School of Dankook University, Cheonan, Korea
,
Jae Sung Lee
3   Department of Orthopaedic Surgery, Medical Center, Chung-Ang University, Seoul, Korea
,
Min Jong Park
4   Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
› Author Affiliations
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Publication History

Publication Date:
23 April 2015 (online)

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Abstract

Background The key to a successful result in the treatment of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) is the restoration of normal alignment of the carpal bones, followed by stable maintenance until healing. This article aimed to assess whether arthroscopic techniques are a reliable surgical option for the treatment of this challenging injury.

Materials and Methods Twenty patients with an acute PLD or PLFD were treated by an arthroscopic technique. They were retrospectively reviewed at an average follow-up of 31.2 months (range 18–61 months). Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) score as well as radiographic evaluations.

Description of Technique Arthroscopic reduction and percutaneous fixation was performed to the scapholunate and lunotriquetral intervals using Kirschner wires (K-wires) as joysticks as well as to the scaphoid using a cannulated headless screw for transscaphoid-type injuries. The K-wires were removed at 10 weeks postoperation.

Results Overall functional outcomes according to the MMWS were rated as excellent in three patients, good in eight, fair in seven, and poor in two. The mean DASH score was 18, and the mean PRWE score was 30. On the basis of radiographic parameters, reduction obtained at the operation was maintained within normal ranges in 15 patients. No patient had developed arthritis by the last follow-up.

Conclusions The medium-term results show that arthroscopic treatment can provide proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes for acute perilunate injuries.

Level of Evidence Level IV.

Keywords

arthroscopy - perilunate - dislocation - fracture-dislocation - percutaneous

Note

A statement of the location where the work was performed (only if authors from multiple institutions): Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135–710, Korea.


 

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