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Abola MV, Gerber BA, Rocks MC, Chen JS, Hacquebord JH, Azad A. A Comparison of Outcomes in Acute Perilunate Injuries: Systematic Review and Meta-Analysis of Treatment Approaches. Hand (N Y) 2024:15589447241231291. [PMID: 38415721 DOI: 10.1177/15589447241231291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Perilunate dislocations (PLD) and fracture-dislocations (PLFD) comprise a spectrum of high-energy wrist injuries. The purpose of this review was to review operative strategies for perilunate injuries based on approach and compare outcomes. METHODS A systematic review of literature on PLD and fracture-dislocations was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed and EMBASE databases were queried for literature. Inclusion criteria included English studies reporting clinical or functional outcomes of acute PLD and PLFD. RESULTS Twenty-nine full-text articles (604 PLD and PLFD injuries) were included. The most common method of PLD and PLFD fixation is through an open approach with combined volar and dorsal exposure. There were no differences between approaches with regard to total arc range of motion, grip strength, Mayo Wrist Score, or mean scapholunate angle. Similarly, there was no difference between approaches and postoperative radiographic arthritis or complications. Most patients were able to return to their prior level of function and work. The incidence of postoperative complications ranged from 0% to 22.5%. CONCLUSION Current evidence shows no difference in postoperative total wrist arc range of motion, grip strength (as compared to contralateral), or Mayo Wrist Score with regard to surgical approach. The most common method of PLD and PLFD fixation in the literature is through an open approach with combined volar and dorsal exposure. There is a large difference in reported rates of radiographic arthritis, although this finding does not appear to correlate with postoperative pain or disability. LEVEL OF EVIDENCE I, Systematic Review.
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Affiliation(s)
- Matthew V Abola
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Brett A Gerber
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Madeline C Rocks
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jeffrey S Chen
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jacques H Hacquebord
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
- Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Ali Azad
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Campano D, Rush K, Gottlich C, Jain N, Bourland B, Mckee D. Dorsal lunate dislocation and en bloc proximal row carpectomy: a case report. J Surg Case Rep 2024; 2024:rjae043. [PMID: 38328456 PMCID: PMC10847405 DOI: 10.1093/jscr/rjae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
An unhelmeted 59-year-old male involved in a motorcycle accident presented with a right dorsal lunate dislocation in the context of a polytrauma evaluation. Soft-tissue attachments were minimal across the carpus, which allowed for an en bloc proximal row carpectomy. Two-year follow-up yielded a satisfactory outcome given the high energy injury mechanism. Proximal row carpectomy is a useful tool which preserves wrist range of motion in the acute trauma setting and is durable, as demonstrated by our patient's postoperative mobilization using a wheelchair.
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Affiliation(s)
- Dominic Campano
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Kaitlin Rush
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Caleb Gottlich
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Neil Jain
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Bryan Bourland
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
| | - Desirae Mckee
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center Lubbock, TX 79430, United States
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Jelti O, Barzouq A, El Alaoui O, Abdeljaouad N, Yacoubi H. Concurrent Palmar Lunate Dislocation and Posterior Elbow Dislocation With a Distal Radius Fracture: A Rare Case Report. Cureus 2024; 16:e52609. [PMID: 38374856 PMCID: PMC10875395 DOI: 10.7759/cureus.52609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
We present an unusual case involving the simultaneous dislocation of the trans-scapho-retro-lunate in the right wrist and a posterolateral dislocation in the right elbow joint with a distal radius fracture in a 23-year-old male with no notable medical history. These injuries occurred when he fell from a height of around 12 meters onto his outstretched right hand. The patient presented to the hospital in a normal upper limb trauma position with no discomfort to critical functions. Predominant symptoms at the emergency department were discomfort in the right wrist, hand, and ipsilateral elbow, as well as the entire upper limb functional impairment. Both the wrist and the elbow seemed distorted on examination, with considerable edema and loss of bone landmarks. Passive mobilization was hampered by pain, but peripheral pulses were detectable. The radial, ulnar, and median nerves' autonomous sensory-motor domains were intact, with a cutaneous opening classified as stage 2 by the Cauchoix-Duparc classification. The elbow dislocation was successfully treated using a closed reduction method. External manipulation was employed to reduce the trans-scaphoid perilunate dislocation, which was subsequently stabilized through percutaneous screw fixation of the scaphoid using a triquetrum-lunate pin. Additionally, a styloid pin was utilized to address and manage a distal radius fracture, followed by the implementation of a radiometacarpal external fixator. After one year and three months, the patient reported no pain in his elbow and minimal wrist discomfort during heavy lifting.
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Affiliation(s)
- Ousama Jelti
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Abdelilah Barzouq
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire (CHU) Mohammed VI, Oujda, MAR
| | - Oussama El Alaoui
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire (CHU) Mohammed VI, Mohammed First University, Oujda, MAR
| | - Najib Abdeljaouad
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Hicham Yacoubi
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
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Liechti R, Merky DN, Grobbelaar AO, van de Wall BJM, Vögelin E, Hirsiger S. Outcomes of acute perilunate injuries-a systematic review. Eur J Trauma Emerg Surg 2023; 49:2071-2084. [PMID: 36750472 DOI: 10.1007/s00068-023-02222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date. MATERIAL AND METHODS This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included. RESULTS Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6-7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2-1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1-0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable. CONCLUSIONS Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Rémy Liechti
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
| | - Dominique Nellie Merky
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Adriaan Ockert Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Stefanie Hirsiger
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
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Moses MJ, Tejwani NC. The Role of External Fixation in the Management of Upper Extremity Fractures. J Am Acad Orthop Surg 2023:00124635-990000000-00671. [PMID: 37071879 DOI: 10.5435/jaaos-d-22-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/19/2023] [Indexed: 04/20/2023] Open
Abstract
External fixation is a powerful tool in the armamentarium of the active orthopaedic surgeon. The upper extremity, however, poses unique challenges in the techniques of external fixation because of the smaller soft-tissue envelope and the proximity of neurovascular structures, which may be entrapped in fracture fragments or traversing in line with pin trajectories. This review article summarizes the indications, techniques, clinical outcomes, and complications of external fixation of the upper extremity in the setting of proximal humerus, humeral shaft, distal humerus, elbow, forearm, and distal radius fractures.
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Affiliation(s)
- Michael J Moses
- From the Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Goodman AD, Harris AP, Gil JA, Park J, Raducha J, Got CJ. Evaluation, Management, and Outcomes of Lunate and Perilunate Dislocations. Orthopedics 2019; 42:e1-e6. [PMID: 30403823 DOI: 10.3928/01477447-20181102-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/07/2018] [Indexed: 02/03/2023]
Abstract
Lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Prompt recognition and treatment is necessary to prevent adverse sequelae, including median nerve dysfunction, carpal instability, posttraumatic arthritis, reduced functionality, and avascular necrosis. In patients who are surgical candidates, operative intervention is warranted to restore carpal kinematics and provide optimal outcomes. [Orthopedics. 2019; 42(1):e1-e6.].
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