Surgical Outcomes of Perilunate Dislocations and Perilunate Fracture-dislocations: A Review of 20 Cases

Abstract

Background: Perilunate dislocations and perilunate fracture-dislocations (PLD/PLFD) are the second most common wrist injuries. Objectives: Given the limited available case series due to the rarity of these injuries, in this study, we report the functional outcomes of 20 patients who received surgical treatment with a mean follow-up of 28 months (range 24-36). Methods: We retrospectively reviewed the admissions to Imam Khomeini Hospital Sari, Iran, and included patients with (PLD/PLFD) who underwent surgical treatment between January 2014 to December 2019. We included 20 patients (16 males, mean age±SD=33.6±12.4) who had received urgent surgical treatment following the initial closed reduction in the emergency department. All of the patients received surgical treatment from the same surgical team using the dorsal approach. Results: We observed the average Mayo Wrist Score (MWS) of 73.8±8.4 (range 65-100) with excellent or good outcomes in 40% of patients. The MWS was slightly higher in patients with the non-dominant injured side, yet it did not significantly differ with those with a dominant hand injury (75.4±9.6 vs. 71.2±5.8, P=0.29). Furthermore, we did not find a significant difference in MWS between the lesser and greater arc injuries (76.5±10.1 vs. 71.1±5.7, P=0.15). The observed flexion and extension ROM were significantly lower than the contralateral side (p <0.001). Similar patterns of lower grip and pinch strength were observed on the injured side, which was significantly lower than the contralateral hand; 38.4±8.6 (74±14% of the contralateral) and 9.9±2.4 (81±15% of the contralateral), respectively (p <0.001). Conclusion: In line with other cohorts, the present case series demonstrates relatively good functional postoperative outcomes in PLD/PLFD. Our findings are comparable with prior reports concerning reasonably satisfactory MWS, ROM relative to the contralateral side and reported occasional mild pain with activity. Future studies should be directed to investigate long-term complications associated with these injuries, particularly the development of wrist osteoarthritis.