gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Perilunate fractures and perilunate dislocations in polytrauma

Meeting Abstract

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  • presenting/speaker Irena Krusche-Mandl - Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
  • Valerie Weihs - Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
  • Arastoo Nia - Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
  • Bernhard Maier - Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
  • Gerhild Thalhammer - Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
  • Stefan Hajdu - Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1946

doi: 10.3205/19ifssh0387, urn:nbn:de:0183-19ifssh03878

Veröffentlicht: 6. Februar 2020

© 2020 Krusche-Mandl et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives/Interrogation: Generally there is a high rate of missed or incorrect diagnosis for perilunate (fracture) dislocations (PD). Especially in severe injured or polytrauma patients the focus of diagnosis and treatment is restoring vital functions, therefore wrist injuries are sometimes diagnosed or treated later. Thus the aim of this study was to analyze the diagnosis, management and outcome of PLF in polytrauma patients in our Level I Trauma Center.

Methods: In this retrospective study all PD in polytrauma between 10/1994 and 09/2017 were included. All 17 patients with a mean age of 36.1 years (range: 17.2-61.1) were male. The mechanism of injury included falls from > 3 meter in ten cases, < 3 meter in three cases and traffic accidents in four cases. The mean injury severity score was 40 (range: 25-75). Most cases (12) were initially diagnosed by conventional x-ray (Gilula-lines, SL-gap,) and by CT scan. In 3 cases it was diagnosed later at an average of 7 days (1-49). 2 patients were transferred to us from another centre.

Results and Conclusions: From the 17 patients one died in the OR, thus 16 were treated surgically.

Reasons for late or alternative care were: precarious soft tissue situation, severe SHT, delayed diagnosis and exitus letalis. We found two cases of persistent carpal instabilities. Range of motion (ROM) will be presented.

Closed reduction should be performed acutely, followed by open reduction and ligamentous and bony repair with internal fixation, whenever possible. In the special setting of polytrauma life threating injuries are of course prioritized influencing the outcome of these severe wrist injuries.