Dorsal perilunate dislocations and fracture-dislocations: Questionnaire, clinical, and radiographic evaluation

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.