PERILUNATE DISLOCATION AND FRACTURE-DISLOCATION - A CRITICAL ANALYSISOF THE VOLAR-DORSAL APPROACH

A combined volar-dorsal approach was used to treat 11 perilunate dislo cations and fracture dislocations between 1989 and 1994. The mean aver age age of the patients was 38 years, and the mean average time betwee n injury and surgery was 13 hours. Outcome was assessed after an avera ge of 30 months. Results were based on measurements of grip strength, range of motion, radiographs, and patient satisfaction. Patient satisf action was high in 9 of 11 patients. Seven had satisfactory pain relie f, and 5 had returned to their previous occupation without limitation. The wrist flexion-extension are and grip strength averaged 71% and 77 %, respectively, compared to the opposite side. Follow-up radiographs demonstrated complete union of all 8 wrist fractures. For all 11 patie nts, the carpal height ratio averaged 0.50. Neither scapholunate disso ciation nor significant dorsal intercalated segmental instability exis ted, but 1 wrist developed scapholunate advanced collapse arthritis. A lthough perilunate instability patterns of injury create significant d erangement in carpal anatomy and are among the most challenging of tra umatic wrist injuries to correct, our results show that a combined vol ar-dorsal approach can be used safely and effectively to restore norma l intercarpal relationships and provide fixation for accompanying frac tures. For the majority of patients, the outcome after this procedure is characterized by acceptable pain relief as well as functional motio n and grip strength.