Jnl Wrist Surg 2018; 07(01): 057-065
DOI: 10.1055/s-0037-1603932
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military

John C. Dunn
1  Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
,
Logan R. Koehler
1  Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
,
Nicholas A. Kusnezov
1  Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
,
Elizabeth Polfer
1  Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
,
Justin D. Orr
1  Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
,
Miguel A. Pirela-Cruz
2  Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
,
Justin S. Mitchell
1  Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas
› Author Affiliations
Further Information

Publication History

11 February 2017

17 May 2017

Publication Date:
28 June 2017 (eFirst)

Abstract

Background Perilunate dislocations and perilunate fracture dislocations (PLDs/PLFDs) are rare and often associated with poor outcomes. Heretofore, these outcomes have not been evaluated in a high-demand military population.

Questions/Purpose The purpose of this study was to evaluate the outcomes in a young, active population after sustaining PLD/PLFD injuries.

Patients and Methods We retrospectively reviewed the U.S. military service members who underwent surgical treatment for a PLD/PLFD (Current Procedural Terminology codes 25695 and 25685) between June 1, 2010, and June 1, 2014 through the Military Health System Management Analysis and Reporting Tool (M2) database, capturing patients with a minimum 2-year follow-up. Patient characteristics and outcomes were gathered; however, radiographic analysis was not possible.

Results In this study, 40 patients (40 wrists) were included with an average follow-up of 47.8 months. The average age was 28.8 years. Twenty-two injuries (55%) were PLFD and 22 (55%) cases involved the nondominant extremity. On initial presentation, 11 (27.5%) were missed and 50% of patients were presented with acute carpal tunnel syndrome. Range of motion (ROM) was 74% and grip strength was 65% compared with the contralateral wrist; 78% reported pain with activity and only 55% remained on active duty status at final follow-up. Injuries to the nondominant extremity were significantly more likely to experience a good to excellent outcome and regained a more ROM. Patients with ligamentous PLD had less pain at rest and were more likely to return to sport.

Conclusion Worse outcomes can be expected for PLD/PLFD of the dominant extremity, transscaphoid PLFD, greater arc injuries, and those undergoing pinning alone. A high-demand patient may expect worse functional results with a higher degree of limitation postoperatively.

Level of Evidence The level of evidence is therapeutic IV.

Note

Some authors are employees of the U.S. Federal Government and the U.S. Army. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of William Beaumont Army Medical Center, the Department of Defense, or U.S. government.