Abstract
Aim:
To assess the clinical outcomes of patients that had perilunate or lunate dislocations treated with either open or closed reduction and wiring without repair of the scapholunate interosseous ligament (SLIL).
Background:
Current literature states that acute perilunate dislocations should be treated with open reduction and repair of the dorsal scapholunate ligament. This is to prevent dissociative carpal instability and potential long term degenerative arthrosis.
Methods:
A retrospective review of patients who sustained a perilunate or lunate dislocation, with no associated radial or carpal fracture was conducted. All were treated by reduction and percutaneous wiring without repair of the SLIL. Patients were examined and data was collected regarding patient's pain, range of motion, grip strength, instability and return to work. All patients had a Mayo wrist score. Pre and post-surgical radiographs were assessed and the scapholunate distance, scapholunate angle and the radiolunate angle were measured. The presence of a high riding scaphoid and osteoarthritis was recorded.
Results:
A total of 13 patients were included in the study, with an average follow up of 32 months. 92% of patients had no pain in their wrist at final follow up. Range of movement was 78% of the normal side. 70% of patients returned to work. 92% of patients had no clinical wrist instability. Grip strength was 82% of the opposite side. Radiographic assessment showed an average scapholunate distance of 2.6 mm, a scapholunate angle of 65° and radiolunate angle of 11°. One of the 13 patients had a high riding scaphoid. 23% of patients had arthritic changes of the carpus on plain radiographs. Of the 13 patients, 3 had excellent mayo scores, 4 good, and 6 fair. No patients had poor scores. Of the 13 patients reviewed 10 returned to work, those that did not were not able to due to other disabilities acquired at the time of their accident.
Conclusion:
Acute management of perilunate dislocations with reduction and percutaneous wiring without repair of the SLIL, resulted in the majority of patients having a pain free, stable, mobile wrist with an above average Mayo wrist score and no arthritic change on radiographic assessment.
