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Jain N, Harder J, Rounds A, Gottlich C, Flores B, Bourland B. Dorsal spanning plate fixation in perilunate injuries: a case report. Case Reports Plast Surg Hand Surg 2024; 11:2332223. [PMID: 38516202 PMCID: PMC10956926 DOI: 10.1080/23320885.2024.2332223] [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: 07/19/2023] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
A 63-year-old male presented with a trans-scaphoid lunate dislocation after a ten-foot fall. Internal fixation included placement of a dorsal spanning plate (DSP). One-year follow-up yielded a satisfactory outcome. A rigid DSP is a useful tool in acute perilunate injuries to protect internal fixation constructs and help with injury rehabilitation.
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Affiliation(s)
- Neil Jain
- Department of Orthopedic Surgery, TX Tech University Health Sciences Center Lubbock, Lubbock, TX, USA
| | - Justin Harder
- Department of Orthopedic Surgery, TX Tech University Health Sciences Center Lubbock, Lubbock, TX, USA
| | - Alexis Rounds
- Department of Orthopedic Surgery, TX Tech University Health Sciences Center Lubbock, Lubbock, TX, USA
| | - Caleb Gottlich
- Department of Orthopedic Surgery, TX Tech University Health Sciences Center Lubbock, Lubbock, TX, USA
| | - Bryant Flores
- Department of Orthopedic Surgery, TX Tech University Health Sciences Center Lubbock, Lubbock, TX, USA
| | - Bryan Bourland
- Department of Orthopedic Surgery, TX Tech University Health Sciences Center Lubbock, Lubbock, TX, USA
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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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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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Crowe CS, Kakar S. Periarticular distal radius fractures and complex ligamentous injury: The role of arthroscopic evaluation. J Orthop 2023; 42:6-12. [PMID: 37389206 PMCID: PMC10302116 DOI: 10.1016/j.jor.2023.06.006] [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] [Received: 03/27/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose Distal radius fractures are associated with a high incidence of concomitant soft tissue injuries, including lesions of the triangular fibrocartilage complex and intercarpal ligaments. While advanced imaging has allowed for greater identification of such tears, discerning which lesions pose a functional consequence remains a challenge for the hand surgeon. A review and guideline for arthroscopic evaluation of suspected combined injuries is presented. Results Arthroscopic evaluation of distal radius fractures provides several unique advantages in such instances. Articular reduction can be performed via direct visualization with improvement in step-off and gapping. Furthermore, ligamentous injuries and carpal alignment can be directly assessed and treated. Conclusions Subtle features of combined ligamentous trauma may be overlooked in the presence of more obvious fracture patterns. Wrist arthroscopy allows not only for a gold-standard method of evaluating of these soft tissue injuries, but also a means of treatment.
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Affiliation(s)
| | - Sanjeev Kakar
- Corresponding author. Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 1st St. Southwest, Rochester, MN, 55905, United States.
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Yi Z, Qi W, Chen S, Zhang Y, Liu B. A Novel Mini-Invasive Technique of Arthroscopic-Assisted Reduction and Robot-Assisted Fixation for Trans-Scaphoid Perilunate Fracture Dislocations. Orthop Surg 2023; 15:1203-1209. [PMID: 36864552 PMCID: PMC10102287 DOI: 10.1111/os.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 03/04/2023] Open
Abstract
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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Affiliation(s)
- Zhe Yi
- Department of Hand Surgery, Beijing JiShuiTan Hospital, The Fourth Clinical College of Peking University, Beijing, China
| | - Weiya Qi
- Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou, China
| | - Shanlin Chen
- Department of Hand Surgery, Beijing JiShuiTan Hospital, The Fourth Clinical College of Peking University, Beijing, China
| | - Yuhao Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo Liu
- Department of Hand Surgery, Beijing JiShuiTan Hospital, The Fourth Clinical College of Peking University, Beijing, China
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Garçon C, Degeorge B, Coulet B, Lazerges C, Chammas M. Perilunate dislocation and fracture dislocation of the wrist: Outcomes and long-term prognostic factors. Orthop Traumatol Surg Res 2022; 108:103332. [PMID: 35609818 DOI: 10.1016/j.otsr.2022.103332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Perilunate dislocations and fracture-dislocations are severe injuries that often have serious functional sequelae. Our goal was to evaluate the long-term clinical and radiological results of these perilunate injuries, and to look for prognostic factors of a poor clinical outcome. HYPOTHESIS All patients who suffered perilunate injuries in their wrist have functional sequelae and long-term radiographic changes despite optimal treatment with anatomical surgical reduction. MATERIALS AND METHODS We did a single-center, retrospective study of 32 patients who had either an isolated perilunate dislocation (n=7) or fracture-dislocation (n=25) in their wrist. Pain, range of motion, strength and functional scores (MWS, PRWE, QuickDASH) were evaluated. Radiographs were analyzed to look for signs of osteoarthritis or carpal instability. RESULTS The mean follow-up time was 9.9years (3.5-24). The wrist joint had a mean flexion-extension of 86° (0-140), radioulnar deviation of 38° (0-65) and pronosupination of 153° (120-180). The mean grip strength was 35kg (5-56). The mean MWS, PRWE and QuickDASH scores were 65/100, 32/100 and 29/100, respectively. At the final assessment, 23 patients (79%) had radiographic signs of osteoarthritis while 5 patients (16%) had residual carpal instability. Three patients subsequently underwent palliative treatment. Opening the carpal tunnel and the magnitude of the lunate's displacement are significant predictors of a poor long-term functional outcome (p<0.05). Older age at the time of injury was a predictor for the development of osteoarthritis. DISCUSSION Despite optimal treatment, perilunate dislocations and fracture-dislocations at the wrist cause functional sequelae such as pain, stiffness, strength deficit and posttraumatic arthritis in nearly 80% of patients. The functional outcomes are determined by the amount of lunate displacement (stage) and the patient's age. We do not recommend opening the carpal tunnel, even when signs of median nerve compression are present; reducing the dislocation helps to relieve the neurological symptoms. LEVEL OF EVIDENCE IV; retrospective observational study.
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Affiliation(s)
- Charline Garçon
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
| | - Benjamin Degeorge
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Bertrand Coulet
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Cyril Lazerges
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Michel Chammas
- Department of orthopedic surgery of the upper limb, hand and peripheral nerve surgery, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
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van der Oest MJ, Duraku LS, Artan M, Hundepool CA, Power DM, Rajaratnam V, Zuidam JM. Perilunate Injury Timing and Treatment Options: A Systematic Review. J Wrist Surg 2022; 11:164-176. [PMID: 35478950 PMCID: PMC9038303 DOI: 10.1055/s-0041-1735841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.
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Affiliation(s)
- Mark J.W. van der Oest
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Liron S. Duraku
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Madina Artan
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dominic M. Power
- Department of Birmingham Hand Centre, Queen Elisabeth Hospital, University of Birmingham, Birmingham, United Kingdom
| | | | - J. Michiel Zuidam
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Abstract
Perilunate dislocations (PLD) and perilunate fracture dislocations (PLFD) are high-energy injuries which can result in long-term complications and significant disability. Early identification of these injuries, followed by prompt, appropriate management is key to optimising patient outcomes. Knowledge of the carpal anatomy is essential in order to understand the varied patterns of injury and plan appropriate definitive management. Emergent reduction and close monitoring of the median nerve, followed by prompt stabilisation or repair of the injured structures remain the mainstay of treatment. In this review, we present a summary of the current evidence regarding the identification and management of these complex injuries.
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Affiliation(s)
- Alison Kinghorn
- Department of Trauma and Orthopaedics, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Graham Finlayson
- Department of Trauma and Orthopaedics, Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, UK
| | - Alastair Faulkner
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, DD1 9SY
| | - Nicholas Riley
- Oxford University Hospitals NHS Foundation Trust, Windmill Road, Headington, Oxford, OX3 7HE, UK
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Garner M, Rudran B, Khan A, Tang Q, Mathew P. Lunate dislocations: anatomy, diagnosis and management. Br J Hosp Med (Lond) 2021; 82:1-10. [PMID: 34338022 DOI: 10.12968/hmed.2021.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.
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Affiliation(s)
- Madeleine Garner
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Branavan Rudran
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK
| | - Amir Khan
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK
| | - Quen Tang
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Philip Mathew
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
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Sánchez JLM, Carrasco VJ, Ribot PZ. Fenton Syndrome: Diagnosis and Treatment with 3D-Printed Models. An Unusual Case Report. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1730000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractScaphocapitate syndrome, also called Fenton syndrome, is a rare, complex condition. Since it is often missed on initial evaluation, it is a diagnostic challenge. A high index of suspicion is required for early surgical treatment, avoiding future palliative surgery or sequelae. Cutting-edge diagnostic technologies, including three-dimensional printed models, are becoming essential tools, enabling the treatment of complex trans-scaphocapitate fracture-dislocations using open reduction and internal fixation with screws, with excellent outcomes at a 12-month follow-up period.
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Affiliation(s)
- José Luis Muñoz Sánchez
- Orthopedic Surgery and Traumatology Department, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
| | - Vladimir Jorge Carrasco
- Orthopedic Surgery and Traumatology Department, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
| | - Pedro Zorrilla Ribot
- Orthopedic Surgery and Traumatology Department, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
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Ribeiro E, Oliveira N, Ribeiro J, Varanda P, Rodrigues LF. Perilunate Lesions – Clinical and Radiological Results with a Minimum of 2 Years of Follow-up. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1729999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractPerilunate injuries are complex and rare lesions with circumferential carpal bones, ligamentous and cartilage involvement. Despite optimal surgical treatment, poor prognosis is expected and usually gets worse over time. Our aim was to address clinical and radiological outcomes after 2 years of follow-up. Seven wrists were revised with average age of 35.59 ± 14.01 (range 21–56) years old and mean follow-up of 44.10 ± 14.24 (range 25.60–68.63) months. At the latest follow-up, mean postoperative VAS score for pain was 2.71 ± 3.40 and DASH score was 10.48 ± 10.54. Patients returned to work in 5.00 ± 3.15 months. Strength and Range of Motion (ROM) parameters were ∼80% of the contralateral side, with exception for extension (61%) and radial deviation (73%). After 2 years of follow-up, radiographic arthrosis was observed in 29% of the cases. One of these patients was symptomatic and was proposed for arthrodesis. Mean carpal height was 1.51 ± 0.81 and scapholunate angle was 41.58 ± 22.82°. A correlation was observed between arthritis found at final follow-up and grip (r = −0.8660; p < 0.001) and pinch strength (r = −0.8885; p < 0.001). In conclusion, despite characteristic guarded prognosis, efforts to perform a prompt and adequate treatment are helpful. Clinical and radiological outcomes may not be related. Thus, it is of main importance to understand patients' perception of their sequelae.
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Affiliation(s)
- Elisabete Ribeiro
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
| | - Nuno Oliveira
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
| | - Juvenália Ribeiro
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
| | - Pedro Varanda
- Department of Orthopaedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
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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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Bhatia DN. Arthroscopic Reduction and Stabilization of Chronic Perilunate Wrist Dislocations. Arthrosc Tech 2016; 5:e281-90. [PMID: 27354948 PMCID: PMC4912605 DOI: 10.1016/j.eats.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/28/2015] [Indexed: 02/03/2023] Open
Abstract
An acute perilunate wrist injury that is unreduced for more than 6 weeks results in severe disability, and even open reduction with stabilization through wide dorsal and volar approaches is technically challenging. This report describes an arthroscopic technique for reduction and percutaneous wire stabilization of a chronic perilunate wrist dislocations. The technique involves initial radiocarpal and midcarpal access through the 6R and 3-4 portals, and these portals are used for synovectomy and debridement of capsular flap tears. The midcarpal joint is accessed initially through the radiocarpal joint, and additional midcarpal portals are used for sequential perilunate adhesiolysis before carpal mobilization and reduction. A percutaneous wire drilled into the lunate is used as a joystick to manipulate the lunate into its anatomic alignment along the carpal bones, and percutaneous transcarpal wire fixation is performed to stabilize the carpus. Arthroscopic and fluoroscopic guidance is used to optimize anatomic reduction and to confirm stability. The wrist is immobilized for 6 weeks; the percutaneous wires are removed thereafter, and the wrist is mobilized. Overall, the arthroscopic technique provides a safe and reproducible method for treatment of this complex chronic injury.
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Affiliation(s)
- Deepak N. Bhatia
- Address correspondence to Deepak N. Bhatia, M.S.(Orth), D.N.B.(Orth), Department of Orthopaedic Surgery, Seth GS Medical College, and King Edward VII Memorial Hospital, Parel, Mumbai 400012, India.Department of Orthopaedic SurgerySeth GS Medical College, and King Edward VII Memorial HospitalParelMumbai400012India
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