PERILUNATE DISLOCATIONS AND FRACTURE-DISLOCATIONS - A MULTICENTER STUDY

A series of 166 perilunate dislocations and fracture-dislocations from 7 centers was retrospectively studied. The diagnosis was missed initi ally in 41 cases (25%). A classification system was presented. The per ilunate fracture-dislocations were more frequent than the perilunate d islocations at a ratio of two to one. The displacement was dorsal in 1 61 cases (97%) and palmar in only 5 (3%). The dorsal transscaphoid per ilunate fracture-dislocations represented 96% of the dorsal perilunate fracture-dislocations and 61% of the whole series. The clinical and r adiologic outcome of 115 peri lunate dislocations and fracture-disloca tions with at least 1 year and an average of 6 years 3 months of follo w-up was studied. Open injury and delay of treatment had an adverse ef fect on clinical results, whereas anatomical type had less influence. In cases treated early, the clinical results were satisfactory but the incidence of posttraumatic arthritis was high (56%). In the dorsal pe rilunate dislocation group of pure ligamentous injuries and in the dor sal transscaphoid group, the best radiologic results were observed aft er open reduction and internal fixation. In the latter group, the fixa tion of the scaphoid alone was not always sufficient and left occasion ally scapholunate dissociation, lunotriquetral dissociation, ulnar tra nslation of the carpus, or other carpal collapse patterns. The initial appraisal of both the osseous and ligamentous pathology was very impo rtant.