G. Inoue et Y. Kuwahata, MANAGEMENT OF ACUTE PERILUNATE DISLOCATIONS WITHOUT FRACTURE OF THE SCAPHOID, Journal of hand surgery. British volume, 22B(5), 1997, pp. 647-652
A retrospective review of 14 cases of acute perilunate dislocations wi
thout fracture of the scaphoid managed by three different forms of tre
atment was conducted at an average follow-up of 29 months. Treatment i
ncluded closed or open reduction with cast immobilization only (n=2),
closed reduction followed by percutaneous K-wire fixation of the carpu
s (n=4), and open reduction with repair of the torn scapholunate ligam
ents and K-wire fixation of the carpus (n=8), Based on Cooney's clinic
al scoring system, there were five excellent, five good, two fair and
two poor results. The patients without ligamentous repair did as well
as those with ligamentous repair when the scaphoid was reduced anatomi
cally and stabilized with K-wires, In the latter, however, the scaphol
ounate relationship was maintained more consistently. We believe that
open reduction through a dorsal approach, direct repair of the scaphol
unate ligaments, and K-wire fixation of the carpus is a reliable metho
d for obtaining satisfactory clinical and radiographic results in the
management of acute perilunate dislocations without fracture of the sc
aphoid.