J Korean Fract Soc.  2011 Oct;24(4):347-353.

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

• Han SH
• Dan JM
• Lee DH
• Kim YW

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 49.0degrees (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.

Keyword

Perilunate dislocations; Dorsal approach; Open reduction

MeSH Terms

Dislocations
Follow-Up Studies
Humans
Surveys and Questionnaires
Reference Values
Retrospective Studies
Wrist

Figure

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

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

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

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

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

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

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

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

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