Open Reduction and Internal Fixation in Old Unreduced Perilunate Injury

Perilunate fracture dislocation (PLFD) and perilunate dislocation (PLD) are wrist injuries, which are commonly missed. Meanwhile, the delay in the treatment of these injuries is leading to a more complicated situation. One of the acceptable treatments for old cases is open reduction and internal fixation.
The purpose of this study was to determine the mid-term results of open reduction and internal fixation (ORIF) treatment for old unreduced perilunate injury that had been unreduced and untreated for a minimum of 6 weeks after injury.
Between 2011 and 2016, 12 patients with old PLFD and PLD, untreated for a minimum of 6 weeks after injury, were treated by ORIF. A retrospective review was performed with a minimum 12 months of follow-up. During the final follow up visit, the patients were evaluated for pain, range of motion, and grip strength. The MAYO wrist score was used for functional assessment. The patients were assessed using a validated Persian questionnaire Quick DASH score. Radiological outcomes were classified using the Herzberg classification.
All of patients were males with a mean age of 25 years (18 to 32 years). Perilunate Fracture Dislocation injury was found in 7 cases and PLD in 5 cases. Mean time from injury to surgery was 14.3 weeks (6 to 26 weeks) and mean follow-up after the surgery was 33.5 months (12 to 60 months). The mean MAYO wrist score was 77.5 (55 to 85). According to the Mayo wrist score, 42% of patients (5 patients) had good, 50% (6 patients) had satisfactory, and 8% (1 patient) had poor results. The active range of flexion-extension averaged 107.5° (range 80 to 155°), and grip strength averaged 84% (range 53% to 100%) of the intact extremity. According to the Herzberg classification, 5 (42%) patients were radiologically located in group A and 7 (58%) in group B. Patients’ satisfaction rate based on the Persian Quick DASH score had an average of 12.5.
Open reduction and internal fixation is an appropriate treatment with acceptable functional and clinical results in old unreduced perilunate injuries up to 6 months after trauma.