İlker ÇOLAK, Güven BULUT, Halil İbrahim BEKLER, Gültekin SITKI ÇEÇEN, Deniz GÜLABİ

Mid-term clinical and radiographic outcomes of perilunate injuries treated with open reduction and internal fixation

Objective: This study aimed to present the mid-term clinical and radiographic outcomes of patients with perilunate injuries treated with openreduction and internal fixation (ORIF).Methods: Patients who underwent ORIF due to perilunate injuries from 2004 to 2015 were retrospectively reviewed. Surgery was mostlyperformed using a standard dorsal approach. Each injury was graded as per Mayfield staging. At the final follow-up, pain intensity was evaluated using a 10-cm visual analog scale (VAS). Wrist and elbow range of motion, handgrip and pinch strength, Modified Mayo Wrist Scores,and the disabilities of the arm, shoulder, and hand (DASH) scores were measured. On plain radiographic examination, the scapholunate (SL)angle, SL interval, carpal height, and continuity of Gilula arcs were evaluated. The presence of arthritis was also assessed using the Herzbergclassification.Results: In total, 26 male patients (27 wrists) who met the inclusion criteria were included in the study. The mean age was 40 years (range:20-58); the mean follow-up was 45 months (range: 16-96).Most of the injuries were fracture-dislocations (n=20; 71.4%). According to Mayfield staging, 7 wrists were grade 3, and 20 wrists were grade4. According to Herzberg staging, 11 (40.7%) patients were stage 2a. The mean VAS was 2.3 (range: 0-5) at rest and 3.3 (range: 0-7) duringactivity. The mean wrist flexion and extension were 50° (range: 21-80°; 73.5% of the unaffected side) and 45.1° (range: 20-74°; 70.9% of theunaffected side), respectively. The mean radial and ulnar deviation were 14.6° (range: 6-25°; 63.6% of the unaffected side) and 22.3° (range:5-40°; 64.7% of the unaffected side), respectively. Grip and pinch strength were 57.6 kg (range: 15-106; 65.5% of the unaffected side) and 18.6kg (range: 8-28; 78.2% of the unaffected side), respectively. The mean Mayo score was 63.3 (range: 20-90), and the DASH score was 24.1±25.2.The mean SL angle was 61.6° (range: 40-83). There was 1 wrist with a pathological SL interval, 11 wrists with dorsal intercalated segmentalinstability, and 3 wrists with fractures of the Gilula arcs. The mean carpal height was within the normal range.Conclusion: In the treatment of perilunate injuries, satisfactory clinical and radiographic outcomes can be expected from ORIF at mid-termfollow-up.Level of Evidence: Level IV, Therapeutic Study

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1. Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: A multicenter study. J Hand Surg Am 1993; 18: 768-79.

2. Gilula LA. Carpal injuries: Analytic approach and case exercises. Am J Roentgenol 1979; 133: 503-17.

3. Herzberg G, Forissier D. Acute dorsal trans-scaphoid perilunate fracture-dislocations: medium-term results. J Hand Surg Br 2002; 27: 498-502.

4. Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: Pathomechanics and progressive perilunar instability. J Hand Surg Am 1980;5: 226-41.

5. Mayfield JK. Mechanism of carpal injuries. Clin Orthop Relat Res 1980; (149): 45-54.

6. Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F. Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up. J Hand Surg Am 2010; 35: 62-8.

7. Kremer T, Wendt M, Riedel K, Sauerbier M, Germann G, Bickert B. Open reduction for perilunate injuries clinical outcome and patient satisfaction. J Hand Surg Am 2010; 35: 1599-1606.

8. Stanbury SJ, Elfar JC. Perilunate dislocation and perilunate-fracture dislocations. J Am Acad Orthop Surg 2011; 19: 554-62.

9. Herzberg G, Burnier M, Marc A, Merlini L, Izem Y. The role of arthroscopy for treatment of perilunate injuries. J Wrist Surg 2015; 4:101-9.

10. Lee SK. Fractures of the carpal bones. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, Cohen MS (Eds): Green’s Operative Hand Surgery. 7th ed. PA: Elsevier, 2017, pp. 588-653.

11. Apergis E. Fracture-Dislocations of the wrist. Springer, Italy, 2013.

12. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8: 1153-7.

13. Otman S, Demiral H, Sade A. Basic Assessment Principles in Treatment Movements (Tedavi Hareketleretlerinde Temel Değerlendirme Prensipleri). 3rd ed. Ankara, Turkey: Prizma Ofset 2003; 62-87.

14. McGrory B, Amadio P. Malunion of the distal radius. In: Cooney W, Linscheid R, Dobyns J (eds): The wrist: diagnosis and operative treatment. St. Louis: Mosby; 1998, pp. 365-384.

15. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29:602- 8.

16. Muller T, Hidalgo Diaz JJ, Pire E, Prunières G, Facca S, Liverneaux P. Treatment of acute perilunate dislocations: ORIF versus proximal row carpectomy. Orthop Traumatol Surg Res 2017; 103: 95-9.

17. Liu B, Chen SH, Zhu J, Wang ZX, Shen J. Arthroscopically assisted mini-invasive management of perilunate dislocations. J Wrist Surg 2015; 4: 93-100.

18. Meszaros T, Vögelin E, Mathys L, Leclère FM. Perilunate fracture-dislocations: Clinical and radiological results of 21 cases. Arch Orthop Trauma Surg 2018; 138: 287-97.

19. Krief E, Appy-Fedida B, Rotari V, David E, Mertl P, Maes-Clavier C. Results of perilunate dislocations and perilunate fracture dislocations with a minimum 15-year follow-up. J Hand Surg Am 2015; 40: 2191-7.

20. Griffin M, Roushdi I, Osagie L, Cerovac S, Umarji S. Patient-reported outcomes following surgically managed perilunate dislocation: Outcomes after perilunate dislocation. Hand (N Y) 2016; 11: 22-8.

21. Oh WT, Choi YR, Kang HJ, Koh IH, Lim KH. Comparative outcome analysis of arthroscopic-assisted versus open reduction and fixation of trans-scaphoid perilunate fracture dislocations. Arthroscopy 2017; 33: 92-100.

22. Dunn JC, Koehler LR, Kusnezov NA, et al. perilunate dislocations and perilunate fracture dislocations in the U.S. military. J Wrist Surg 2018; 7: 57-65.

23. Çolak İ, Bekler Hİ, Bulut G, Eceviz E, Gülabi D, Çeçen GS. Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation. Acta Orthop Traumatol Turc 2018; 52: 32-6.

24. Yu Y, Yu X, Bai Y, Wu T, Shao X. Acute and delayed trans-radial perilunate dislocations:open reduction and internal fixation. Int J Clin Exp Med 2016; 9: 2573-8.

25. Chou YC, Hsu YH, Cheng CY, Wu CC. Percutaneous screw and axial Kirschner wire fixation for acute transscaphoid perilunate fracture dislocation. J Hand Surg Am 2012; 37: 715-20.