Abstract
Perilunate dislocations and perilunate fractures are serious wrist injuries which are often overlooked at primary treatment. Their inadequate therapy results in severe wrist damage and patient disability.
An early diagnosis and correct therapy can prevent such conditions.A group of 25 patients with 26 wrist injuries is presented. It included nine patients with isolated perilunate dislocations (34%), 11 patients with trans-scaphoid perilunate dislocations (44%),two with trans-radial trans-scaphoid perilunate dislocations (7%) and next two patients with trans-radial perilunate dislocations (7%).
One patients had, in addition to perilunate dislocation, injury to the capitohamat joint with damage to both portions of the interosseous ligament (4%). One patient (4%) sustained a trans-scaphoid perilunate dislocation with injury to the scapholunate ligament, in which the proximal pole of the scaphoid was separated and interfered with dislocation reduction.
The correct diagnosis was made on early examination in 16 patients (62%), within a week of injury in four patients (15%), within a months of injury in two patients (8%) and even later in four patients (15%). The results of treatment evaluation based on the Wrightington Hospital Wrist Scoring System were excellent in 19%, good in 54%, satisfactory in 19% and poor in 8% of the patients.
The poor result in one patient was due to necrosis of the lunate bone;the diagnosis of a perilunate dislocation was made within a month of injury. The poor results in the other patient were associated with complex regional pain syndrome.
Perilunate injuries of the wrist are quite frequent and although the treatment procedure is commonly known, its principles are not always obeyed. A good outcome is related to an early diagnosis and correct reconstruction of the injured structures.
In our group, the diagnosis was made at the first examination in only 62% of patients and later than a week after injury in 23%.