Two stage treatment of old perilunate fracture dislocation using external fixator

Perilunate dislocation and fracture-dislocation are rare injuries. Treatment of these injuries can be more challenging in old and neglected cases. In this study we report the outcomes of a two- stage treatment of old and neglected cases of these injuries by applying a distracting external fixator (first stage) and open reduction 3-4 weeks later (second stage).

In this retrospective study, seven patients who underwent the two-stage treatment were included. Outcome measurements included Visual Analogue Scale (VAS) for pain, functional evaluation of the wrist by Disabilities of the Arm, Shoulder, and Hand (DASH), power and pinch grip assessment, radiocarpal range of motion and arthrosis in the radiocarpal and mid carpal joints.

Mean time interval between the injury and surgery was 7±4.9 months. Mean follow up period was 16.8±10.7 months. Grip strength of the injured hand was 82.1% of the contralateral hand. Pinch strength of the involved hand was 82.5% of the contralateral hand. Range of motion in the radiocarpal joint of the injured hand was 49.6% in flexion/extension and 64.6% in ulnar/radial deviation of the uninjured hand, respectively. Mean VAS and DASH score were 4.1 and 28.5, respectively. Scaphoid nonunion was seen in one patient and radiocarpal joint arthrosis occurred in another one.

According to the acceptable result of this study, we recommend two-stage treatment for the management of old perilunate injuries.