gms | German Medical Science

Objectives: The purpose of this study is to investigate clinical, radiological and functional results of patients who were treated surgically due to a trans-scaphoid perilunate fracture-dislocation.

Methods: Between 2008 and 2012, 11 patients (all male, average age is 35 ) who were undergone an open reduction and internal fixation with trans-scaphoid perilunate fracture-dislocation had been reviewed retrospectively. Eight patients were diagnosed right after initial trauma, other 3 patients were diagnosed in between 10-27 days after initial trauma. All patients were operated with a dorsal incision, one patient needed an additional volar incision. We used K wires (for 5 patients) and headless screws (for 6 patients) for fixation scaphoid and other fracture-dislocations. Postoperatively immediate rehabilitation started after 6-12 weeks cast immobilization. Range of motion of wrist, VAS score and radiological investigation were conducted at follow-up examinations.

Results and Conclusion: All internally fixed fractures were healed and no loss of reduction pseudoarthrosis or avascular necrosis was observed. Compared to the other extremities, there were mild extension loss (average : 38 degrees) in the operated extremity. Compared to other hands grip strength the operated extremity had reached to 77.5 % of normal grip strength. Preoperatively increased radiologic SL angle and SL interval had been reduced to normal values (SL angle: 47-64 degrees SL interval: 1,2-2,40 mm) in the last follow-up. According to VAS scores 5 patients had moderate pain and other patients had no or mild pain at last follow-up examination.

Patients who suffered from a trans-scaphoid perilunate fracture-dislocation will have anatomically aligned and clinically good functional wrists if this injury is diagnosed early and surgically stable fixation is achieved.