DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20184393

Outcome assessment of two stage reduction and fixation in neglected trans scaphoid peri lunate fracture dislocation

Ratan Lal Dayma, Rahul Temani, Prashant Modi, Vijay Prakash Yadav, Jitesh Jain

Abstract


Background: Perilunate instability is a type of carpal instability complex. Perilunate injuries occur after high-energy traumas to the wrist or falls on the outstretched hand.

Methods: The hospital based prospective study was held in the department of Orthopaedics, SMS medical college and Hospital, Jaipur from April 2016 to November 2017. It included 25 cases of neglected trans scaphoid peri lunate fracture dislocation treated in 2 stages surgical procedures.

Results: Median nerve was involved in 6 (24%) patients. Pain was also graded as subjective pain. Most of patients had pain free wrist at 1 year follow up post surgery while 2 patients had pain on routine activity, 5 patients had pain on sternous activity and pain was permanent in 1 patient. Mean scapholunate and radiolunate angles were 54 degrees (range 40 to 60 degrees) and 9.8 degrees (range 5 to 15 degrees) on the immediate postoperative radiographs and 54.8 degrees (range 40 to 65 degrees) and 10.6 degrees (5 to 20 degrees) at 1 years follow up. Mild degenerative changes were seen in the radiocarpal joint in 3 patients and in midcarpal joint in 4 patients one patient had both radiocarpal joint arthritis and midcarpal joint arthritis two patients developed superficial pin tract infection.

Conclusions: On the basis of our study we finally conclude staged reduction should be considered for neglected trans scaphoid peri lunate dislocations.


Keywords


Scaphoid peri lunate, Dislocations, Midcarpal joint, Radiocarpal joint

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References


Johnson RP. The acutely injured wrist and its residuals. Clin Orthop. 1980;149:33–44.

Herzberg G, Comtet JJ, Linschied RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am. 1993;18:768–79.

Sauder DJ, Athwal GS, Faber KJ, Roth JH. Perilunate injuries. Orthop Clin North Am 2007;38:279-88.

Hildebrand KA, Ross DC, Patterson SD, Roth JH, MacDermid JC, King GJ. Dorsal perilunate dislocations and fracture-dislocations: question- aire, clinical, and radiographic evaluation. J Hand Surg Am. 2000;25:1069-7.

Dobyns JH, Linscheid RL, Chao EYS. Traumatic instability of the wrist. In: AAOS instructional course lectures. St Louis: CV Mosby, 1975: 182-199.

Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist: diagnosis, classification and pathomechanics. J Bone Joint Surg. 1972;54:1612-32.

Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg. 1980;5:226-41.

Dobyns JH, Linscheid RL. In: Rockwood CA, Green DP (eds). Fractures in adults. 2nd ed. Philadelphia: JB Lippincott. 1984;41:l-509.

Sennwald G. L’entite radius-carpe. Springer Verlag. 1987;76-82:189-91.

Green DP, O’Brien ET. Open reduction of carpal dis- locations: indications and operative techniques. J Hand Surg 1978;3:250-65.

Knoll VD, Allen C, Trumble TE. Trans-scaphoid perilunate fracture dis- locations: results of screw fi xation of the scaphoid and lunotriquetral repair with a dorsal approach. J Hand Surg Am. 2005;30:1145-52.

Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F. Perilunate dis- locations and transscaphoid perilunate fracture-dislocations: a retrospec- tive study with minimum ten-year follow-up. J Hand Surg Am. 2010;35:62-8.

Green DP, O’Brien ET. Open reduction of carpal dis- locations: indications and operative techniques. J Hand Surg. 1978;3:250-65.

Fenton RL. The naviculo-capitate fracture syndrome. J Bone Joint Surg Am. 1956;38(3):681–4.

Trumble T, Verheyden J. Treatment of isolated perilunate and lunate dislocations with combined dorsal and volar approach and intraosseous cerclage wire. J Hand Surg Am. 2004;29(3):412–7.

Viegas SF, Bean JW, Schram RA. Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation. J Hand Surg Am. 1987;12(6):992–9.

Moneim MS, Hofammann KE, Omer GE. Transscaphoid perilunate fracture-dislocation. Result of open reduction and pin fixation. Clin Orthop Relat Res. 1984;190:227–35.

DiGiovanni B, Shaffer J. Treatment of perilunate and transscaphoid perilunate dislocations of the wrist. Am J Orthop. 1995;24(11):818–26.

Herzberg G, Forissier D. Acute dorsal transscaphoid perilunate fracture-dislocations: mediumterm results. J Hand Surg Br. 2002;27(6):498–502.

MacAusland WR. Perilunar dislocation of the carpal bones and dislocation of the lunate bone. Surg Gynecol Obstet. 1944;79:256.

Campbell RD, Thompson TC, Lance EM, Adler JB. Indications for open reduction of lunate and perilunate dislocations of the carpal bones. J Bone Joint Surg Am. 1965;49:915–37.

Garcia-Elias M, Ribe M, Rodriguez J, Cots M, Casas J. Influence of joint laxity on scaphoid kinematics. J Hand Surg Br. 1995;20(3):379–82.

Inoue G, Kuwahata Y. Management of acute perilunate dislocations without fracture of the scaphoid. J Hand Surg [Br]. 1997;22:647-52.

Kailu L, Zhou X, Fuguo H. Chronic perilunate dislocations treated with open reduction and internal fixation: results of medium-term follow-up. Int Orthop. 2010;34:1315–20.