Perilunate Injury Timing and Treatment Options: A Systematic Review

Duraku, Liron S.; Artan, Madina; Hundepool, Caroline A.; Power, Dominic; Rajaratnam, Vaikunthan; Zuidam, J. Michiel

doi:10.1055/s-0041-1735841

Cited by 9 publications

(15 citation statements)

References 37 publications

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“…Although acceptable outcomes can be achieved by reported conventional open procedures, open surgery introduces additional surgical trauma to the important capsular and ligamentous structures and may damage the already fragile blood supply to scaphoid and torn ligament 13 . A recent systematic review 14 suggests that prompt surgical intervention with minimal invasion offers mildly better results than open reduction and internal fixation for PLFDs. Previous studies have shown that the use of wrist arthroscopy allows anatomic reduction of the fractures and dislocations associated with PLFDs 5,6 .…”

Section: Discussionmentioning

confidence: 99%

A Novel Mini‐Invasive Technique of Arthroscopic‐Assisted Reduction and Robot‐Assisted Fixation for Trans‐Scaphoid Perilunate Fracture Dislocations

Chen

et al. 2023

Orthopaedic Surgery

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Objective Perilunate injuries are rare but devastating carpal injuries. The treatment of perilunate injuries remains challenging and contentious. This study aims to describe a novel mini‐invasive surgical technique of arthroscopic‐assisted reduction and robot‐assisted fixation for the treatment of trans‐scaphoid perilunate fracture dislocations (PLFDs). Methods We retrospectively reviewed patients with PLFDs after surgical treatment from February 2021 to March 2021. The patients underwent arthroscopic‐assisted precise reduction and robot‐assisted headless screw fixation. Times of guide wire placement were recorded intraoperatively. Periodic follow‐up was performed until union of scaphoid fracture was confirmed. Range of motion of the wrist, grip strength, the Visual Analog Scale (VAS) score, the Mayo Wrist Score, the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, the Patient‐Rated Wrist Evaluation (PRWE), and osteoarthritis were evaluated at the final follow‐up. Results Two male patients presenting with PLFDs with an average age of 24.5 years old (32 and 17 years) were included in this study. Intraoperatively, anatomic reduction of the scaphoid fracture was achieved under arthroscopic guidance. A robotic‐assisted single‐attempt guidewire insertion was performed for scaphoid fracture and lunotriquetral interval. The CT scans at 8 and 12 weeks showed the union of the scaphoid fracture. At final mean follow‐up of 13.5 months, the extension, radial‐ulnar deviation, and pronation‐supination were consistent with the contralateral side in both patients. One patient experienced mild limited range of motion with the flexion 46° of the injured wrist compared with 81°of the contralateral wrist. The VAS score was 0 and 2. The grip strength was 32 and 26 kg compared with 24 and 42 kg of the contralateral wrist. The PRWE score was 13 and 10 and the QuickDASH score was 2 and 7. The Mayo Wrist Score was 100 and 65. No sign of osteoarthritis was found at the last follow‐up. Conclusions Arthroscopic‐assisted reduction and robot‐assisted fixation is a viable and promising alternative for the treatment of perilunate fracture dislocations. This technique allows precise reduction and accurate placement of the K‐wires/screws into the carpal bones through the optimal biomechanical paths.

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Section: Discussionmentioning

confidence: 99%

A Novel Mini‐Invasive Technique of Arthroscopic‐Assisted Reduction and Robot‐Assisted Fixation for Trans‐Scaphoid Perilunate Fracture Dislocations

Chen

et al. 2023

Orthopaedic Surgery

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“…Herzberg (2008) demonstrated that injuries presenting more than 45 days from injury had significantly worse outcomes. These delayed presentations may be better suited for salvage procedures, such as proximal row carpectomy or wrist fusion (Herzberg, 2008; van der Oest et al., 2022).…”

Section: Perilunate Injuries: Perilunate Dislocation and Lunate Dislo...mentioning

confidence: 99%

Carpal dislocations

Heineman,

Do,

Golden

2023

J Hand Surg Eur Vol

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Carpal dislocations result from sequential disruption of the complex relationship between the bones and ligaments of the wrist. Injuries to the carpus occur via predictable mechanisms, an understanding of which is critical to identify and treat these frequently missed patterns of injury and to avoid the sequela of chronic instability. Lunate dislocations are by far the most common, but isolated dislocation of other carpal bones can also occur. Open reduction and internal fixation still remains the gold standard for treatment regardless of the debate around the specific approaches. These high-energy injuries are associated with significant long-term morbidity even when identified promptly and appropriately treated. This review will focus on the evaluation and management of common forms of carpal dislocations.

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“…With regards to operative techniques, there is debate on the role of open-reduction internal xation (ORIF) versus closed reduction internal xation. Most studies suggest using a dorsal-only approach if doing an ORIF, however the indications for including a volar approach to the carpal tunnel have not been elucidated (5,8,(10)(11)(12)(13)(14). The optimal technique for intra-operative xation warrants further investigation as does the timing of xation removal, immobilization and therapy protocols (1).…”

Section: Introductionmentioning

confidence: 99%

The Canadian Prospective Pragmatic Perilunate Outcomes (C3PO) Trial; A Protocol

Mitchell,

Tottenham,

Grewal

et al. 2024

Preprint

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Background Perilunate spectrum injuries (PSI) are uncommon, but high-energy injuries that result in significant functional implications for patients. The existing literature on PSI is limited to small case-series and there are no evidence-based guidelines for management. Methods This manuscript outlines a protocol for a three-armed, national, multi-centre study, which includes a patient injury registry for PSI, as well as associated retrospective and prospective arms. The primary objective is to establish a national injury registry for patients who present with PSI. The secondary objectives are to examine the long-term clinical and radiographic outcomes of PSI, evaluate progression of these outcomes over time, and to examine the impact of specific operative and injury related factors on outcomes. Discussion This paper describes the protocol for a three-armed, multi-centre study of PSI. It outlines the rationale for the study as well as the relevant methodological details. An injury registry involving multiple centres is valuable given this is an uncommon injury with many potential variables affecting outcomes. Registry-based retrospective and prospective studies will benefit from the large clinical database provided by the registry and could be used to guide evidence-based treatment guidelines which are currently lacking in the literature. Trial registration Clinicaltrials.gov identifier: NCT04370626

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Perilunate Injury Timing and Treatment Options: A Systematic Review

Cited by 9 publications

References 37 publications

A Novel Mini‐Invasive Technique of Arthroscopic‐Assisted Reduction and Robot‐Assisted Fixation for Trans‐Scaphoid Perilunate Fracture Dislocations

A Novel Mini‐Invasive Technique of Arthroscopic‐Assisted Reduction and Robot‐Assisted Fixation for Trans‐Scaphoid Perilunate Fracture Dislocations

Carpal dislocations

The Canadian Prospective Pragmatic Perilunate Outcomes (C3PO) Trial; A Protocol

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