Abstract

• 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.
• Key words: lunate dislocation, perilunate dislocation, transcaphoid perilunate dislocation

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