gms | German Medical Science

Objectives/Interrogation: Perilunate dislocations are rare injuries of the wrist occuring in high energy trauma and hence missed in the emergency room. Management consists of early closed reduction or open reduction, fracture fixation and ligament repair. Previous studies have used different approaches and the management has been towards fracture fixation and scapholunate ligament repair, however with no clear management of lunotriquetral joint. We highlight upon combined volar-dorsal approach for definitive treatment in perilunate dislocations with or without other carpal bone fractures, their diagnosis and management.

Methods: Patient were included from a tertiary referral center between August 2015 to August 2017 with a minimum follow up of one year. All patients underwent closed reduction in emergency under conscious sedation or external fixation when not reducible as soon as possible considering these were patient with high energy trauma. Once the swelling subsided they were taken up for definitive management with open reduction and fixation with ligament repairs. Intraoperative findings were recorded and patients were followed up at regular intervals. Assessment were made in terms of fracture healing, range of movements, pain, radiological angles and wrist scoring.

Results and Conclusions: There were 22 patients among which 19 were males, all involving high energy trauma with road traffic accidents as the most common cause and fall from a height of more than 3m being the second most common cause. 18 patients had closed reducion in emergency and 4 patients needed reduction and external fixation. All patients underwent combined volar and dorsal approach with fracture fixation and ligament repairs. Grade 3-4 Scapholunate injuries were noted in all 10 patients who had pure ligamentous type of perilunate dislocation which were repaired and stabilized with Scapholunate and Scapho capitate wires. Lunotriquetral ligament was torn in all which was addressed using the volar approach by direct repair and K wire fixation. One patient had scaphoid non union, Average range of motion was 90 degrees in flexion-extension, persistent VISI was seen in 2, DISI in 4 with Grade 4 scapholunate tears and 18 patinets had good results using the Mayo wrist scoring.

Using combined volar and dorsal approaches for perilunate dislocations is of paramount importance to address both the scapholunate and lunotriquetral ligaments along with fracture fixation.