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

Abstract

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. The purpose of this study was to evaluate the outcomes in a young, active population after sustaining PLD/PLFD injuries. 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. 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. 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. The level of evidence is therapeutic IV.

Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Foveal Tear Repair in the United States Military

“…For these reasons, outcomes of upper-extremity injuries in the military have been guarded compared with those in the civilian population. 38,39 Despite these potential influences, the current cohort had promising postoperative outcome scores, a high return to full duty rate (93%) and a low complication rate (7%) after almost 4 years' follow-up. The patients involved in this study were on activity duty status without restriction or profile and had daily physical activity requirements as cadets and midshipmen.…”

Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome

“…58,59 Trauma Anterior Lunate Dislocation Anterior lunate dislocation (ALD) generally results from high-energy trauma such as a fall or motor vehicle collision. [60][61][62] The diagnosis of ALD relies on careful inspection of plain radiographs. Early detection is important to minimize carpal instability, degenerative changes, and CTS.…”

“…61,62 Since many patients with acute and chronic ALD present with symptoms of CTS, the sonologist should be familiar with the US appearance of ALD. [61][62][63] In ALD, sagittal and axial sonograms show the displacement of the lunate and compression by its anterior pole against the FDTs and MN (Figure 14). Ultrasound visualization of the distal articular face of the lunate, which usually articulates with the proximal pole of the capitate, is the hallmark of ALD.…”

“…Anterior lunate dislocation (ALD) generally results from high‐energy trauma such as a fall or motor vehicle collision 60‐62 . The diagnosis of ALD relies on careful inspection of plain radiographs.…”

“…Early detection is important to minimize carpal instability, degenerative changes, and CTS. Nevertheless, the diagnosis of ALD is delayed in up to 27.5% of cases 61,62 . Since many patients with acute and chronic ALD present with symptoms of CTS, the sonologist should be familiar with the US appearance of ALD 61‐63 .…”