Citation Information :
Savvidou OD, Beltsios M, Sakellariou VI, Mavrogenis AF, Christodoulou M, Papagelopoulos PJ. Use of external fixation for perilunate dislocations and fracture dislocations. 2014; 9 (3):141-148.
The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation. Twenty patients (18 males and two females) with a mean age of 38 years (range 18–59) who had an acute dorsal perilunate dislocation or fracture dislocation were treated with the use of wrist external fixator and K-wires. The injuries included 12 perilunate dislocations, seven trans-scaphoid perilunate fracture dislocations, and one trans-styloid perilunate fracture dislocation. The median time from trauma to operation was 8 h (2–12 h). Indirect reduction via ligamentotaxis was achieved in all perilunate dislocation, and provisional K-wire fixation was added. In five of seven trans-scaphoid perilunate fracture dislocations, indirect reduction was achieved; whereas in the other two as well as in the case of trans-styloid perilunate fracture dislocation, open reduction was required. External fixator was supplemented with K-wires for stabilization of the fractures and the intercarpal intervals. The interosseous and capsular ligaments were not repaired, even after open reduction of fracture dislocations. The mean follow-up was 39 months (range 18–68 months). Range of motion and grip strength were measured. Cooney's scoring system was used for the assessment of clinical function. Radiographic evaluation included time to scaphoid union, measurement of radiographic parameters (scapholunate gap, scapholunate angle, lunotriquetral gap, and carpal height ratio) and any development of arthritis. The flexion-extension motion arc and grip strength of the injured wrist averaged 80 and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney's clinical scoring system, overall functional outcomes were rated as excellent in four patients, good in eight, fair in six, and poor in two. Eighteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid; one of them required scaphoid excision and midcarpal fusion. Two patients had radiographic evidence of arthritis. The use of external fixation and provisional K-wire fixation for the treatment of acute perilunate dislocations is associated with satisfactory midterm functional and radiographic outcomes. This minimally invasive treatment option is simple, reliable, and minimally invasive method that provides proper restoration and stable fixation of carpal alignment.
Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J (1993) Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg 18(5):768
Siegert JJ, Frassica FJ, Amadio PC (1988) Treatment of chronic perilunate dislocations. J Hand Surg 13(2):206
Adkison JW, Chapman MW (1982) Treatment of acute lunate and perilunate dislocations. Clinical Orthop Relat Res 164:199
Herzberg G, Forissier D (2002) Acute dorsal trans-scaphoid perilunate fracture-dislocations: medium-term results. J Hand Surg 27(6):498
Knoll VD, Allan C, Trumble TE (2005) Trans-scaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid and lunotriquetral repair with a dorsal approach. J Hand Surg 30(6):1145
Minami A, Kaneda K (1099) Repair and/or reconstruction of scapholunate interosseous ligament in lunate and perilunate dislocations. J Hand Surgery 18(6):1993
Sauder DJ, Athwal GS, Faber KJ, Roth JH (2007) Perilunate injuries. Orthop Clin North Am 38(2):279
Weil WM, Slade JF 3rd, Trumble TE (2006) Open and arthroscopic treatment of perilunate injuries. Clin Orthop Relat Res 445:120
Budoff JE (2008) Treatment of acute lunate and perilunate dislocations. J Hand Surg 33(8):1424
Hildebrand KA, Ross DC, Patterson SD, Roth JH, MacDermid JC, King GJ (1069) Dorsal perilunate dislocations and fracturedislocations: questionnaire, clinical, and radiographic evaluation. J Hand Surg 25(6):2000
Mayfield JK, Johnson RP, Kilcoyne RK (1980) Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg 5(3):226
Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214:136
Kindynis P, Resnick D, Kang HS, Haller J, Sartoris DJ (1990) Demonstration of the scapholunate space with radiography. Radiology 175(1):278
Linscheid RL, Dobyns JH, Beabout JW, Bryan RS (2002) Traumatic instability of the wrist: diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 84(1):142
Nattrass GR, King GJ, McMurtry RY, Brant RF (1994) An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am 76(1):88
Linscheid RL, Dobyns JH, Beabout JW, Bryan RS (1972) Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 54(8):1612
Youm Y, McMurthy RY, Flatt AE, Gillespie TE (1978) Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg Am 60(4):423
Apergis E, Maris J, Theodoratos G, Pavlakis D, Antoniou N (1997) Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases. Acta Orthop Scand Suppl 275:55
Melone CP Jr (2000) Murphy MS, Raskin KB. Perilunate injuries. Repair by dual dorsal and volar approaches. Hand Clin 16(3):439
Herzberg G (2008) Perilunate and axial carpal dislocations and fracture-dislocations. J Hand Surgery 33(9):1659
Osterman AL, Seidman GD (1995) The role of arthroscopy in the treatment of lunatotriquetral ligament injuries. Hand Clin 11(1):41
Ritter MR, Chang DS, Ruch DS (1999) The role of arthroscopy in the treatment of lunotriquetral ligament injuries. Hand Clin 15(3):445
Ruch DS, Smith BP (2001) Arthroscopic and open management of dynamic scaphoid instability. Orthop Clin North Am 32(2):233
Slade JF, Lozano-Calderon S, Merrell G, Ring D (2008) Arthroscopic-assisted percutaneous reduction and screw fixation of displaced scaphoid fractures. J Hand Surg Eur 33(3):350
Toh S, Nagao A, Harata S (2000) Severely displaced scaphoid fracture treated by arthroscopic assisted reduction and osteosynthesis. J Orthop Trauma 14(4):299
Whipple TL (1995) The role of arthroscopy in the treatment of scapholunate instability. Hand Clin 11(1):37
Fernandez DL, Jakob RP, Buchler U (1983) External fixation of the wrist. Current indications and technique. Ann Chir Gynaecol 72(6):298
Fernandez DL, Ghillani R (1987) External fixation of complex carpal dislocations: a preliminary report. J Hand Surg 12(3):335
Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F (2010) Perilunate dislocations and transscaphoid perilunate fracturedislocations: a retrospective study with minimum ten-year follow- up. J Hand Surg 35(1):62
Souer JS, Rutgers M, Andermahr J, Jupiter JB, Ring D (2007) Perilunate fracture-dislocations of the wrist: comparison of temporary screw versus K-wire fixation. J Hand Surg 32(3):318