Abstract
Background The purpose of this study was to review clinical and radiographic outcomes of perilunate
dislocations (PLDs) and fracture-dislocations (PLFDs) treated with external fixation
and Kirschner wires (K-wires).
Materials and Methods Twenty patients (18 males and 2 females) with a mean age of 38 years (range 18–59)
with an acute PLD or PLFD were treated with external fixator and K-wires. There were
12 PLDs and seven transscaphoid and one transstyloid PLFDs. The median time from trauma
to operation was 8 hours (range 2–12 hours).
Indirect reduction via ligamentotaxis was achieved in 17 patients with a mean age
of 38years (range 18–59). There were 12 PLDs and 5 trans-scaphoid PLFDs; however,
in three cases (two transscaphoid and one transstyloid PLFDs), indirect reduction
failed and an open reduction was required. The intercarpal ligaments were not repaired
even after open reduction.
Results The mean follow-up was 39 months (range 18–68 months). The flexion-extension range
of motion (ROM) and grip strength of the injured wrist averaged 80% and 88%, respectively,
of the corresponding values for the contralateral wrists. According to Cooney's scoring
system, overall functional outcomes of the 17 patients were rated as excellent in
4 patients, good in 8, fair in 4, and poor in 1. Fifteen patients returned to their
former occupations. Two patients with a trans-scaphoid perilunate injury developed
nonunion of the scaphoid, and two developed posttraumatic arthritis.
Conclusion External fixation plus percutaneous K-wires for the treatment of acute PLDs has satisfactory
midterm functional and radiographic outcomes. When successful, this minimally invasive
technique is simple and provides restoration of the carpal alignment. It may especially
be useful in the polytrauma patient, thanks to its decreased operative time and diminished
blood loss, when other emergent surgical procedures may be necessary. An open reduction
with possible fixation may be necessary for PLDs and PLFDs, especially in the presence
of polytrauma and scaphoid comminution.
Level of evidence: IV.
Keywords
carpal dislocation - wrist external fixation - percutaneous pinning - ligamentotaxis
