Surgical treatment of late carpal dislocations.
Background. Perilunate carpal subluxation is quite rare. The aim of our study was to assess outcome in the delayed treatment of these injuries. Material and methods. We studied treatment outcome in 25 perilunate carpal dislocations. The follow-up averaged 11 years and 4 months. The age of the patients ranged from 18 to 52 (average 32). The period from injury to surgery ranged from 1 day to 360 days (average 60 days). The range of motion and grip strength of the wrist were evaluated. In radiological assessment the ulnar dislocation index, carpal height index, and capitolunate, radiolunate, and scapholunate angles were examined. Subjective evaluation was based on the DASH questionnaire. Results. Only slight changes were observed during the observation period in the radiological parameters. There was no significant correlation between the use of traction in preparation for open reduction and the radiological, functional or subjective outcome. Contrary to expectations none of the outcome measures correlated with the type of dislocation or patient age, or with the delay from injury to surgery. In DASH evaluations, the strongest correlation was found between the subjective outcome and the radiological parameters, global grip strength, the sum of all four measures of range of movement, and wrist flexion. In three cases there were late complications: one case of aseptic necrosis of the lunate bone, and two cases of scaphoid pseudarthrosis. Conclusions. The best method of late treatment for perilunate carpal dislocation proved to be open reduction using the dorsal approach with Kirschner wire fixation.
Lorczyński
Adam
A
Katedra Ortopedii i Traumatologii Narzadu Ruchu AM, Gdańsk.
Baczkowski
Bogusław
B
Mazurek
Tomasz
T