Journal of Musculoskeletal Trauma

Perilunate Dislocation and Perilunate Fracture-Dislocation: Jung Il Lee; J Korean Fract Soc 2022;35(3):114-119. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.114

Abstract PDF: Perilunate dislocations and perilunate fracture-dislocations are one of the most severe forms of wrist injuries and are generally caused by high-energy trauma such as falls from a height or traffic accidents. Prompt recognition and immediate, gentle closed reduction are critical, but diagnosis can often be missed at the initial presentation. The current standard management is open reduction, ligamentous and bony repair, and supplemental fixation for the protection of the repair. The pathomechanics of the injury, diagnosis by plain wrist radiographs, closed reduction techniques, current surgical treatments, and complications are presented in this review.

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Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach: Soo Hong Han, Jin Myoung Dan, Dong Hoon Lee, Young Woong Kim; J Korean Fract Soc 2011;24(4):347-353. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.347

Abstract PDF: PURPOSE
To evaluate the clinical and radiologic outcomes of the perilunate dislocation and the lunate dislocation which were managed surgically through a dorsal approach.
MATERIALS AND METHODS
Retrospective reviews of the 13 patients who had minimum 1-year follow-up after surgical treatment through isolated dorsal approach for their perilunate dislocations or the lunate dislocations were performed. The case that dislocated lunate migrated proximally through the wrist was excluded in this series. We evaluated the DASH score in questionnaire method and Mayo wrist score to analyze the clinical outcomes. Radiologic results were investigated by measurement of the scapho-lunate angle, and fracture union was also evaluated in the case of trans-scaphoid dislocation.
RESULTS
The mean DASH Score was 16.3 points (range, 10.8~26.7 points) and the mean Mayo wrist score was 79 points (range, 65~90 points) at the final follow-up. There were 2 cases of excellent, 7 cases of good and 4 cases of fair in the Mayo wrist score. On the radiologic analysis, the mean scapho-lunate angle was 49.0degrees (range, 35~55degrees) and all cases were within the normal range. All cases of the trans-scaphoid perilunate dislocation achieved bone union.
CONCLUSION
Author's cases showed satisfactory outcomes in clinically and radiologically. Isolated dorsal approach could give anatomical reduction and appropriate internal fixation in treatment of the perilunate dislocations and the lunate dislocations except the rare case of proximal migration of the lunate through the wrist.

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Volar Perilunate Dislocation: A case report: Sung Soo Kim, Sung Keun Sohn, Dae Hee Lee; J Korean Soc Fract 1999;12(2):440-445. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.440

Perilunar dislocation is not a common injury. When it occurs it is usually dorsal. Only a few isolated cases have been reported of volar perilunar dislocation, in which the capitate is displaced volar to the palmar flexed lunate. Like its more common dorsal counterpart, volar perilunate dislocation usually requires either a concomitant fracture of the scaphoid or scapholunate dissociation. Many authors have been proposed the mechanism of injury, forced hyperflexion, hyperextension with supination of the forearm and violent trauma with extensor tendon rupture. The diagnosis is most easily made on the lateral view. Closed reduction using finger-trap traction should be the initial step in management. Although successful treatment has been reported with a closed reduction alone, open reduction is probably indicated in most cases to align and stabilize the bones. We are reporting on a patient of volar perilunar dislocation without a fracture of the scaphoid or scapholunate dissociation of the right hand associated with extensor tendon rupture.

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Combined Lunate and Triquetrum Fracture: A Case Report
Joo-Hak Kim, Hyung-Soo Kim, Soo-Tae Chung, Jeong-Hyun Yoo, Seung-Do Cha, Joong-Hyo Lee, Jai-Hyung Park
Journal of the Korean Fracture Society.2008; 21(4): 320. CrossRef

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Lunate dislocation and perilunte dislocation with or without fracture: Won Jong Bahk, Jong Min Sohn, Nam Gee Lee, Seung Key Kim, Young Joo Park, Han Chang; J Korean Soc Fract 1996;9(1):42-49. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.42

Abstract PDF: The lnate dislocation and perilunte dislocation with or without fracture, occupying about 10% of carpal injury, might b classified as a same category of injury resulted from similar mechanim. Initial diagnosis was missed often. In case of failure of closed reduction, open reduction and internal fixation will be necessary. The authors analyzed retrospectively 15 patients with lunate dislocation and perilunate dislication without fracture(Group A)and perlunate dislication with scaphoid fracture(Group B) who were treated from 1989 to 1994 at our hespital. The follow-up periods were 7 months to 60 months with mean of 23.2 months. The results were as follows. 1.Group A were 2 cases of anterior dislication of lunate and 8 cases of perilunate dislocation Group B were 5 cases of transscaphoid perilunate fracture-dislocation. The direction of perilunar dislocation with or without scaphoid fracture was posterior in all cases. 2.The causes of injury were fall from height in 7 cases, slip in 3 cases, traffic accident in 3 cases and crushing injury in 2 cases. 3.The overall clinical results by modified Green and OBriens clinical score were excellent in 4 cases(26.7%), good in 4 cases (26.7%),fair in 4 cases(26.7)and poor in 3 cases(20%). 4.9 out of 10 cases (90%) in Group A and 3 out of 5 cases(60%) in Group B were superior to fair. Early treatment within 3 days injury was performed in 11 cases (7 in Group A,4 in Group B), The average point was 85 and 70, respectively and there was no statisticat significance between two groups(P>0.05). Treatment was delayed beyond two weeks after injury due to missed initial diagnosis and open wound in 4 cases(3 in Group A,1 in Grdup B). The final tesults were 1 case of good, 1 case of fair, 1 case of poor in Group a, and 1 case of poor in Group B. There was no statistical significance between the early treatment cases and delayed treatment cases(P>0.05). In conclusion, ounate and perilunate dislocation without scaphoid fracture can be treated by early operation to get and maintain the anatomical reduction. The authors thought that the presence of scaphoid fracture, nonanatomic reduction and delay in treatment are poor prognostic factors.

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Fracture of the Capitate with Velar Perilunate Dislocation: One case report: Kwang Hyun Lee; J Korean Soc Fract 1995;8(4):908-913. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.908

Abstract PDF: Fracture of the capitate is a rare form of carpal injuries. It can occur with perilunate dislocation. In that case, capitate fracture associated with scaphoid fracture is common enough that it has been called the scaphocapitate fracture(or syndrome). A rare case of a displaced fracture of the capitate and unusual locked volar perilunate dislocation without scaphoid fracture is described. This carpal injury was treated by closed reduction and percutaneous pinning with one K-wire and the result is now excellent. A possible explantation of the mechanism underlying this conditian is offered and the literature is reviewed.

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