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Trauma

STAGED REDUCTION OF NEGLECTED TRANSSCAPHOID PERILUNATE DISLOCATION: A REPORT OF 16 CASES

European Federation of National Associations of Orthopaedics and Traumatology (EFORT) - 12th Congress



Abstract

Introduction

Transscaphoid perilunate dislocation is a rare injury and therefore it is easily missed at the initial treatment. Once ignored, an alternative treatment such as proximal row carpectomy is indicated, but surgical outcome is not as good as that of an early reduction. Also late reduction (> 3 months) is not possible and needs extensive dissection. We present an alternative technique of staged reduction with better outcome.

Material & Methods

16 cases (14 males & 2 females) with neglected Transscaphoid perilunate dislocation (> 3 month old) were treated with staged reduction. In first stage an external fixator was applied across the wrist and distraction was done at 1mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation.

Results

The mean duration between two surgeries was 2.4 weeks (range 2–4 weeks). 13 cases had excellent results, one had fair result. Two patients developed reflex sympathetic dystrophy and had poor results.

Conclusion

Staged reduction should be considered for neglected Transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome.