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J Wrist Surg
DOI: 10.1055/a-2781-2873
Survey or Meta-Analysis

Neglected Perilunate Fracture–Dislocations: A Systematic Review and Meta-analysis

Authors

  • J. Terrence Jose Jerome 

    1   Department of Orthopaedics and Traumatology, Dhanalakshmi Srinivasan Medical College, Perambalur, Consultant, Department of Orthopaedics, Hand and Reconstructive Microsurgery, Trichy, India

  • G. Surendran

    1   Department of Orthopaedics and Traumatology, Dhanalakshmi Srinivasan Medical College, Perambalur, Consultant, Department of Orthopaedics, Hand and Reconstructive Microsurgery, Trichy, India

  • Thirumagal K.

    1   Department of Orthopaedics and Traumatology, Dhanalakshmi Srinivasan Medical College, Perambalur, Consultant, Department of Orthopaedics, Hand and Reconstructive Microsurgery, Trichy, India
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Abstract

Background

Neglected perilunate fracture–dislocations are uncommon yet disabling wrist injuries, typically resulting from missed diagnoses after high-energy trauma. Chronic cases (>6 weeks' postinjury) present formidable reconstructive challenges due to fibrosis, malalignment, and arthritic change. Although traditional teaching discouraged late reduction, advances in staged distraction, internal fixation, and salvage techniques have redefined management expectations. This systematic review and meta-analysis synthesized available evidence on treatment strategies, functional outcomes, and complications in chronic or neglected perilunate injuries.

Materials and Methods

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, Scopus, Embase, and Web of Science were searched (1983–2025) for studies reporting outcomes of perilunate dislocations treated ≥6 weeks after trauma. Data extracted included patient demographics, injury chronicity, surgical method, and functional results (Mayo Wrist Score, QuickDASH, range of motion, grip strength, and arthritis). A random-effects meta-analysis pooled the proportion of patients achieving “good/excellent” results, whereas heterogeneous data were summarized descriptively.

Results

Thirteen studies (158 patients) met the inclusion criteria. Most were young males (mean: 30 years) sustaining high-energy mechanisms; 59% were transscaphoid fracture–dislocations, 30% ligamentous perilunate dislocations, and 11% isolated lunate dislocations. Median delay to treatment was 4.5 months (range: 6 weeks–16 years). Open reduction and internal fixation (ORIF) predominated (49%), followed by proximal row carpectomy (34%) and limited wrist fusion (7%). The pooled proportion of good/excellent Mayo Wrist Scores was 60% (95% confidence interval: 48–72). Mean postoperative flexion–extension arc reached approximately 50% of the contralateral side and grip strength approximately 85%. Radiographic arthritis developed in approximately 28%, but few required later arthrodesis. Staged distraction-assisted reduction improved outcomes in markedly chronic presentations.

Conclusion

Even after prolonged delay, selected patients with neglected perilunate fracture–dislocations may achieve meaningful function and pain relief. ORIF within 4 to 6 months appears associated with better functional scores than later reconstruction, whereas very late presentations often necessitate salvage procedures. However, these conclusions are based on very low-certainty evidence from small, heterogeneous observational studies, and should be interpreted with caution

Level of Evidence

Level IV

Keywords

neglected perilunate dislocation - open reduction and internal fixation - staged distraction - proximal row carpectomy - four-corner fusion

Contributors' Statement

J. Terrence Jose Jerome, G. Surendran, Thirumagal K.: Roles/writing—original draft, data curation, conceptualization, writing—drawing, review, and editing.


Ethical Approval

This study is a systematic review and meta-analysis of previously published, deidentified data and did not involve direct human participation, interventions, or access to identifiable patient information. In accordance with national guidelines and institutional policy, it qualifies for ethics review exemption.


The protocol was nonetheless submitted to the Institutional Ethics Committee, Olympia Hospital and Research Centre, Tiruchirappalli (Trichy), India, which granted an exemption/approval under the reference OHR-ERC/2025/0473. The Committee confirmed that informed consent and additional safeguards were not required for the use of aggregated, publicly available data.


All procedures adhered to the Declaration of Helsinki, PRISMA 2020 guidance for systematic reviews, and good research practices.


Registration of Research Studies

1. Name of the registry: POSPERO awaiting approval ID-


2. Unique Identifying number or registration ID: Not applicable.


3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.


Guarantor

J. Terrence Jose Jerome


Supplementary Material



Publication History

Received: 01 November 2025

Accepted: 05 January 2026

Article published online:
23 January 2026

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