Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Background: Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries. Materials and Methods: 9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores. Results: The physical rehabilitation was started at 6^th week, after the K-wires were removed. The average followup was 18.2 months (range 12–28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°. Conclusion: The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

[1]  B. Erol,et al.  Isolated volar surgical approach for the treatment of perilunate and lunate dislocations , 2014, Indian journal of orthopaedics.

[2]  Chun-Ying Cheng,et al.  Percutaneous screw and axial Kirschner wire fixation for acute transscaphoid perilunate fracture dislocation. , 2012, The Journal of hand surgery.

[3]  C. Allan,et al.  In Brief: Mayfield et al. Classification: Carpal Dislocations and Progressive Perilunar Instability , 2012, Clinical orthopaedics and related research.

[4]  A. Michot,et al.  [Perilunate dislocations and fracture-dislocations of the wrist, a review of 17 cases]. , 2012, Chirurgie de la main.

[5]  M. Milošević,et al.  Treatment of trans-scaphoid perilunate dislocations using a volar approach with scaphoid osteosynthesis and temporary Kirschner wire fixation. , 2011, Military medicine.

[6]  C. Kammerlander,et al.  [Stabilization of perilunate and transscaphoid perilunate fracture-dislocations via a combined palmar and dorsal approach]. , 2009, Operative Orthopadie und Traumatologie.

[7]  L. Catalano,et al.  Carpal dislocations. , 2006, Hand clinics.

[8]  T. Trumble,et al.  Trans-scaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid and lunotriquetral repair with a dorsal approach. , 2005, The Journal of hand surgery.

[9]  G. Herzberg,et al.  Acute Dorsal Trans-Scaphoid Perilunate Fracture-Dislocations: Medium-Term Results , 2002, Journal of hand surgery.

[10]  S. Kozin,et al.  Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. , 2001, The Journal of hand surgery.

[11]  C. Melone,et al.  Perilunate injuries. Repair by dual dorsal and volar approaches. , 2000, Hand clinics.

[12]  K. Raskin,et al.  Long-term assessment of proximal row carpectomy for chronic perilunate dislocations. , 1999, Journal of Hand Surgery-American Volume.

[13]  G. Inoue,et al.  Late Treatment of Unreduced Perilunate Dislocations , 1999, Journal of hand surgery.

[14]  N. Antoniou,et al.  Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases. , 1997, Acta orthopaedica Scandinavica. Supplementum.

[15]  G. Inoue,et al.  Management of Acute Perilunate Dislocations without Fracture of the Scaphoid , 1997, Journal of hand surgery.

[16]  J. Herndon,et al.  Perilunate dislocation and fracture dislocation: a critical analysis of the volar-dorsal approach. , 1997, The Journal of hand surgery.

[17]  J. Shaffer,et al.  Treatment of perilunate and transscaphoid perilunate dislocations of the wrist. , 1995, American journal of orthopedics.

[18]  R. L. Linscheid,et al.  Perilunate dislocations and fracture-dislocations: a multicenter study. , 1993, The Journal of hand surgery.

[19]  W Barnaby,et al.  Fractures and dislocations of the wrist. , 1992, Emergency medicine clinics of North America.

[20]  R. Smith,et al.  Kinematics of the ulnar carpus related to the volar intercalated segment instability pattern. , 1990, The Journal of hand surgery.

[21]  J. Kelleher.  Minami, A., et al. Correlation between clinical results and carpal instabilities in patients after reduction of lunate and perilunate dislocations , 1987 .

[22]  R. L. Linscheid,et al.  Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. , 1987, Clinical orthopaedics and related research.

[23]  M. Chapman,et al.  Treatment of acute lunate and perilunate dislocations. , 1982, Clinical orthopaedics and related research.

[24]  R. L. Linscheid,et al.  Management of post-traumatic instability of the wrist secondary to ligament rupture. , 1978, The Journal of hand surgery.