Open Access
American Research Journal of Orthopedics and Traumatology
ISSN (Online): 2572-2964
DOI: 10.46568/arjot
Management of Acute Trans Scaphoid Peri-Lunate Fracture Dislocation by Closed Reduction and Percutaneous Fixation
Abstract
Background: Perilunate fracture dislocations (PLFD) are high-energy injuries, produced by wrist hyperextension. Isolated Perilunate dislocations are rare and can be missed.
Patients and methods: 20 patients (15 males, 5 females) suffered from traumatic trans-scaphoid perilunate fracture dislocation, all cases were palmar dislocation. Right wrists were injured in 14 patients and left wrists in 6 patients. The mean age of the patients at the time of injury was 33 years (range 19 to 45). The fracture scaphoid was fixed using Herbert screw in 16 cases, and K-wires in 4 patients. Clinical function was evaluated by the Cooney clinical scoring system. Plain X-ray was done for all patients preoperative, direct postoperative, and every visit until the end of follow up period. The radiological outcome included the revised carpal height ratio, radio-lunate angle (RL), scapholunate angle (SL), and presence or absence of midcarpal arthritis.
Results: The average follow-up period was 20 months (range 18 –30). Clinically, according to the clinical scoring system described by Cooney, there were 6 (30%) patients with excellent results, 10 (50%) good, and 4 (20%) fair and no poor results were recorded during follow up period. Radiologically, the scaphoid fracture was united in all cases with no evidence of avascular necrosis. The average SL and RL angles in the early postoperative period were 46.5 and −6.0 degrees, respectively. At the last follow-up, average SL and RL angles were 52 and 4.5 degrees, respectively which is significant (p: 0.002). Revised carpal height ratio was 1.53 at the last follow-up.
Conclusion: Closed reduction and percutaneous fixation of scaphoid fracture is considered an effective method for management of acute trans-scaphoid perilunate fracture dislocation provided that accurate anatomic reduction of carpal bones is achieved.
Patients and methods: 20 patients (15 males, 5 females) suffered from traumatic trans-scaphoid perilunate fracture dislocation, all cases were palmar dislocation. Right wrists were injured in 14 patients and left wrists in 6 patients. The mean age of the patients at the time of injury was 33 years (range 19 to 45). The fracture scaphoid was fixed using Herbert screw in 16 cases, and K-wires in 4 patients. Clinical function was evaluated by the Cooney clinical scoring system. Plain X-ray was done for all patients preoperative, direct postoperative, and every visit until the end of follow up period. The radiological outcome included the revised carpal height ratio, radio-lunate angle (RL), scapholunate angle (SL), and presence or absence of midcarpal arthritis.
Results: The average follow-up period was 20 months (range 18 –30). Clinically, according to the clinical scoring system described by Cooney, there were 6 (30%) patients with excellent results, 10 (50%) good, and 4 (20%) fair and no poor results were recorded during follow up period. Radiologically, the scaphoid fracture was united in all cases with no evidence of avascular necrosis. The average SL and RL angles in the early postoperative period were 46.5 and −6.0 degrees, respectively. At the last follow-up, average SL and RL angles were 52 and 4.5 degrees, respectively which is significant (p: 0.002). Revised carpal height ratio was 1.53 at the last follow-up.
Conclusion: Closed reduction and percutaneous fixation of scaphoid fracture is considered an effective method for management of acute trans-scaphoid perilunate fracture dislocation provided that accurate anatomic reduction of carpal bones is achieved.
