Correlation between clinical results and carpal instabilities in patients after reduction of lunate and perilunar dislocations

Minami, Akio; Ogino, Toshihiko; Ohshio, Itaru; Minami, Masayasu

doi:10.1016/0266-7681(86)90263-9

Cited by 27 publications

(7 citation statements)

References 10 publications

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“…20 Two years after surgery those with residual LT incongruity (N ¼ 2) did as well as patients with anatomic carpal relationships, and patients with an SL gap greater than 3 mm (N ¼ 3) had significantly greater pain, worse range of motion, and weaker grip.…”

Section: The Evidence Surgical Approachmentioning

confidence: 96%

Perilunate Dislocations

Vitale¹,

Seetharaman²,

Ruchelsman³

2015

The Journal of Hand Surgery

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A 37-year-old man injured his right wrist in a motor vehicle collision. In the emergency department he had severe wrist pain and median nerve paresthesia. Wrist radiographs identified a dorsal perilunate dislocation (PLD) with the carpus dislocated dorsally and the lunate tilted volar but still located in the lunate fossa. Post-reduction computed tomography scan confirmed no fractures. THE QUESTIONSWhat is the optimal surgical approach for this patient with a purely ligamentous (i.e., "lesser arc" 1 ) dorsal PLD? What bones should be immobilized and what is the best method of internal fixation? CURRENT OPINIONPLDs are high-energy carpal injuries that result in wrist stiffness and arthrosis even if good carpal alignment is restored. 2e7 PLD merits urgent reduction when there is associated median nerve dysfunction, CME INFORMATION AND DISCLOSURESThe Review Section of JHS will contain at least 2 clinically relevant articles selected by the editor to be offered for CME in each issue. For CME credit, the participant must read the articles in print or online and correctly answer all related questions through an online examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details.The JHS CME Activity fee of $15.00 includes the exam questions/answers only and does not include access to the JHS articles referenced.

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Section: The Evidence Surgical Approachmentioning

confidence: 96%

Perilunate Dislocations

Vitale¹,

Seetharaman²,

Ruchelsman³

2015

The Journal of Hand Surgery

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“…The scapho-lunate gap is important to evaluate the functional outcome. It is suggested that a scapho-lunate gap >3 mm leads to a poorer functional outcome 20. The scapholunate interval at the final control was measured as 2.1 mm (range 1.6-2.4 mm) and this was maintained throughout the routine controls.…”

Section: Discussionmentioning

confidence: 99%

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Başar

Erol

et al. 2014

IJOO

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Background:Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries.Materials and Methods:9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores.Results:The physical rehabilitation was started at 6th week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°.Conclusion:The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

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“…17,26 Some patients with radiographic evidence of persistent LT malalignment after perilunate dislocation may have minimal symptoms and a satisfactory outcome. 27,28 LT sprains that are symptomatic present invariably with intermittent ulnar-sided wrist pain that is noticeable with wrist deviation. 2,26 Patients present with weakness, diminished motion, sensations of instability or giving way, and ulnar nerve paresthesias.…”

Section: Evaluation Of Lunotriquetral Injuriesmentioning

confidence: 98%