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

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

doi:10.12671/jkfs.2011.24.4.347

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Han, Dan, Lee, and Kim: Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(4): 347-353.

Published online: 30 October 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.4.347

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.

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 14 June 2011 Revised 2 August 2011 Accepted 30 September 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Perilunate dislocations, Dorsal approach, Open reduction

Figures and Tables

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.

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