Ka. Hildebrand et al., Dorsal perilunate dislocations and fracture-dislocations: Questionnaire, clinical, and radiographic evaluation, J HAND S-AM, 25A(6), 2000, pp. 1069-1079
Twenty-two consecutive patients (23 wrists) underwent open reduction intern
al fixation of dorsal perilunate dislocations and fracture-dislocations thr
ough combined dorsal and volar approaches. One of 5 experienced wrist surge
ons performed these procedures within an average of 3 days of injury (range
, 0-26 days) and intercarpal fixation was kept within the proximal carpal r
ow. Motion was instituted an average of 10 weeks (range, 5-16 weeks) after
injury. All patients were males. The average age at the time of injury was
32 years (range, 16-60 years). The average follow-up period was 37 months (
range, 13-65 months). Average flexion-extension motion are and grip strengt
h in the injured wrist were 57% and 73%, respectively, compared with the co
ntralateral wrist. The scapholunate angle increased and the revised carpal
height ratio decreased over time, which was statistically significant for b
oth measurements. Three patients (3 wrists) required wrist arthrodesis and
a fourth patient had an immediate scaphoid excision and 4-corner arthrodesi
s secondary to an irreparable scaphoid fracture. One patient required a pro
ximal row carpectomy to treat septic arthritis. Nine of the remaining 18 wr
ists had radiographic evidence of arthritis, most often at the capitolunate
or scaphocapitate articulations. Short form-36 mental summary scores were
significantly greater than age- and gender-matched US population values, ph
ysical summary scores were significantly less. The disabilities of arm, sho
ulder, and hand evaluation, Mayo wrist score, and patient-rated wrist evalu
ation all reflected loss of function. Seventy-three percent of all patients
had returned to full duties in their usual occupations and a total of 82%
were employed. Copyright (C) 2000 by the American Society for Surgery of th
e Hand.