gms | German Medical Science

Objectives/Interrogation: Perilunate dislocations are complex wrist injuries. Despite optimal treatment, permanent partial loss of wrist motion and grip strength is expected. Due to its rarity, only few reports including treatment outcomes exist in the literature. Here, the authors describe clinical and radiological results after perilunate dislocations and fracture-dislocations.

Methods: Retrospective study including 12 patients that underwent surgery for closed perilunate dislocations and perilunate fracture-dislocations of the wrist, between January 2012 and December 2016. All patients were male and mean age was 34,54±11,96 years old (range 22-56). Clinical evaluation included wrist range of motion, power strength and grip strenght measures. Visual Analogue Scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were applied. Radiological assessment was performed with plain radiographs. Statistical analysis was displayed with Graph Pad Prism 6 for Windows 10.

Results and Conclusions: After 49,94±16,47 months of follow-up (range 25,60±76,50), mean range of motion values (comparing to contralateral side) were: flexion 89,63±50,59%, extension 60,81±26,87%, radial deviation 72,84±34,48%, ulnar deviation 77,77±35,81%, pronation 101,97±11,97% and supination 79,57±31,92%. Mean power strength and pinch strength were 82,18±16,68% and 91,09±27,16%, respectively. Post-operative pain and DASH score were 2,58±2,93 and 10,77±12,37, respectively. The mean carpal height ratio was 1,54±0,08 (range 1,44-1,64) and the mean scapholunate angle was 50,73º±9,95º (range 32,00º-66,00º). Arthritic changes were found in 25% of the patients. Two patients had a scaphoid non-union. One patient developed scapholunate dissociation. DASH scores correlated with supination and power strength and pinch strength p<0.05), but not with other motion parameters neither radiological results. Age significantly correlated with final degenerative changes (p<0.05).

Our data overlap current literature on what concerns functional results. Most of the parameters reach 80% of the contralateral side values. Lower extension values do not correlated with DASH scores, meaning those are still acceptable results for these patients. Carpal height ratio and scapholunate angles were preserved for the majority of the patients. We believe that the low rate of degenerative changes comparing to other papers could be explained by the shorter follow-up period. Age might pose as an important indicator for wrist arthritis.