ORIF OF DORSAL PERILUNATE FRACTURE-DISLOCATIONS AND PROGNOSTIC FACTORS

Abstract

Introduction: Perilunate injuries are rare entities and can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). Purpose of treatment is anatomic reduction and stable fixation. We aimed to present radiologic and functional results of surgically treated (ORIF) dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis.
Methods: Between 2015 and 2020, 12 patients were operated for perilunate fracturedislocations in our institute. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated in terms of radiologic evaluation.
Results: Mean follow-up was 26 (range, 12-48) months. The average age at surgery was 35.7 (range, 18-51) years. 10 patients were male and two were female. Functional results were excellent in two (16.7%), good in one (8.3%), satisfactory in 4 (33.3%) and poor in five (41.7%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 9 wrists (82.4%). In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results.
Conclusion: Despite anatomic reduction, ligamentous and chondral injuries which occured at the time of trauma may result in persistent wrist pain. Mechanism of injury, soft tissue defects and the duration between injury and treatment can affect clinical and radiologic results.