Soo-Hong Han; Jin-Myoung Dan; Dong-Hoon Lee; Young-Woong Kim

doi:10.12671/jkfs.2011.24.4.347

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Original Article
Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach: Soo-Hong Han, M.D., Jin-Myoung Dan, M.D., Dong-Hoon Lee, M.D., Young-Woong Kim, M.D.; Journal of the Korean Fracture Society 2011;24(4):347-353.
DOI: https://doi.org/10.12671/jkfs.2011.24.4.347
Published online: October 30, 2011

Department of Orthopaedic Surgery, CHA University CHA Bundang Medical Center, Seongnam, Korea.

^*Department of Orthopaedic Surgery, CHA University CHA Gumi Medical Center, Gumi, Korea.

Address reprint requests to: Jin-Myoung Dan, M.D. Department of Orthopaedic Surgery, CHA University CHA Gumi Medical Center, 855, Hyungkok-dong, Gumi 730-040, Korea. Tel: 82-31-780-5289, Fax: 82-31-708-3578, hsoohong@cha.ac.kr

• Received: June 14, 2011 • Revised: August 2, 2011 • Accepted: September 30, 2011

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Abstract
REFERENCES

Abstract

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 49.0° (range, 35~55°) 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.
Key words: Perilunate dislocations, Dorsal approach, Open reduction

REFERENCES

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2. Budoff JE. Treatment of acute lunate and perilunate dislocations. J Hand Surg Am, 2008;33:1424-1432.Article
3. Chung MS, Lee CS, Suk SI. Clinical study of the trans-scaphoid perilunar dislocation. J Korean Soc Fract, 1988;1:43-53.
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5. Forli A, Courvoisier A, Wimsey S, Corcella D, Moutet F. Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up. J Hand Surg Am, 2010;35:62-68.
6. Green DP, O'Brien ET. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am, 1978;3:250-265.
7. Herzberg G. Acute dorsal trans-scaphoid perilunate dislocations: open reduction and internal fixation. Tech Hand Up Extrem Surg, 2000;4:2-13.
8. Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med, 1996;29:602-608.
9. Inoue G, Imaeda T. Management of trans-scaphoid perilunate dislocations. Herbert screw fixation, ligamentous repair and early wrist mobilization . Arch Orthop Trauma Surg, 1997;116:338-340.
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12. Moneim MS, Hofammann KE 3rd, Omer GE. Transscaphoid perilunate fracture-dislocation. Result of open reduction and pin fixation. Clin Orthop Relat Res, 1984;190:227-235.
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Fig. 1

Volarly dislocated lunate is seen through the space between 3~4 extensor compartments by dorsal approach.

Fig. 2

(A) The ruptured scapholunate ligament and lunotriquetral ligament are repaired with anchor suture.

(B) Firmly fixed scapholunate ligament is seen.

Fig. 3

On initial radiographs of 48-year-old male injured by 2 m falling down, the lunte is dislocated volarly.

Fig. 4

The alignment of the carpal bones are well maintained on radiographs at 1 year follow-up.

Fig. 5

The flexion-extension arch of the wrist is 110o 1 year after surgery.

Fig. 6

On initial radiographs of 22-year-old male after 1.5 m falling down, trans-scaphoid dorsal perilunate dislocation is seen.

Fig. 7

On radiographs 14 months after surgery, the scaphoid is unioned and the carpal alignment is normal.

Fig. 8

The flexion-extension arch of the wrist is 130o 14 months after surgery.

Table 1

Average angle of flexion-extension arch of the wrist and average grip power

^*Group 1: Trans-scaphoid perilunate dislocation, ^†Group 2: Perilunate dislocation, ^‡Group 3: Lunate dislocation.

Table 2

Average DASH score and average Mayo score

^*Group 1: Trans-scaphoid perilunate dislocation, ^†Group 2: Perilunate dislocation, ^‡Group 3: Lunate dislocation.

Table 3

Comparison of results among 3 groups^* (by Kruskal-Wallis test)

^*3 groups: Trans-scaphoid perilunate dislocation, Perilunate dislocation, Lunate dislocation.

Figure & Data

REFERENCES

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Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach

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

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Figure

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Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach

Fig. 1 Volarly dislocated lunate is seen through the space between 3~4 extensor compartments by dorsal approach.

Fig. 2 (A) The ruptured scapholunate ligament and lunotriquetral ligament are repaired with anchor suture. (B) Firmly fixed scapholunate ligament is seen.

Fig. 3 On initial radiographs of 48-year-old male injured by 2 m falling down, the lunte is dislocated volarly.

Fig. 4 The alignment of the carpal bones are well maintained on radiographs at 1 year follow-up.

Fig. 5 The flexion-extension arch of the wrist is 110o 1 year after surgery.

Fig. 6 On initial radiographs of 22-year-old male after 1.5 m falling down, trans-scaphoid dorsal perilunate dislocation is seen.

Fig. 7 On radiographs 14 months after surgery, the scaphoid is unioned and the carpal alignment is normal.

Fig. 8 The flexion-extension arch of the wrist is 130o 14 months after surgery.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach

Table 1

Average angle of flexion-extension arch of the wrist and average grip power

^*Group 1: Trans-scaphoid perilunate dislocation, ^†Group 2: Perilunate dislocation, ^‡Group 3: Lunate dislocation.

Table 2

Average DASH score and average Mayo score

^*Group 1: Trans-scaphoid perilunate dislocation, ^†Group 2: Perilunate dislocation, ^‡Group 3: Lunate dislocation.

Table 3

Comparison of results among 3 groups^* (by Kruskal-Wallis test)

^*3 groups: Trans-scaphoid perilunate dislocation, Perilunate dislocation, Lunate dislocation.

Table 1 Average angle of flexion-extension arch of the wrist and average grip power

^*Group 1: Trans-scaphoid perilunate dislocation, ^†Group 2: Perilunate dislocation, ^‡Group 3: Lunate dislocation.

Table 2 Average DASH score and average Mayo score

^*Group 1: Trans-scaphoid perilunate dislocation, ^†Group 2: Perilunate dislocation, ^‡Group 3: Lunate dislocation.

Table 3 Comparison of results among 3 groups* (by Kruskal-Wallis test)

^*3 groups: Trans-scaphoid perilunate dislocation, Perilunate dislocation, Lunate dislocation.