MANAGEMENT OF ACUTE PERILUNATE DISLOCATIONS WITHOUT FRACTURE OF THE SCAPHOID

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.