title: Early and delayed treatment of dorsal transscaphoid perilunate fracture-dislocations.
abstract: OBJECTIVE
  Transscaphoid perilunate fracture-dislocations are complex injuries. The aim of this study is to discuss and compare open reduction and internal fixation for acute and delayed transscaphoid perilunate fracture-dislocations and review the literature.
  
  
  METHODS
  The design of this study is retrospective and randomized.
  
  
  METHODS
  Gülhane Military Medical Academy, Department of Orthopedics and Traumatology.
  
  
  METHODS
  Twelve cases (6 acute and 6 delayed) of dorsal stage 2 fracture-dislocations were involved in the study.
  
  
  METHODS
  Scaphoid fractures were treated with reduction and internal fixation by using either a cannulated screw or a Herbert screw. Temporary triquetrocapitate and lunotriquetral fixation were performed in all cases using two 1.8-mm Kirschner wires after reduction of the dislocations.
  
  
  METHODS
  Range of motion (flexion and extension), grip strength evaluation with Jamar dynamometer, comparison of preoperative and early postoperative average of scapholunate (SL) and radiolunate angle (RL), and revised carpal height ratio were used for outcomes assessment. Clinical evaluation was performed according to the clinical scoring system modified from Green and O'Brien. Revised carpal height ratio, SL angle, RL angle, and appearance of midcarpal arthritis were used for radiologic analysis.
  
  
  RESULTS
  Average follow-up period was 45 months (23-70). Mean clinical score of early treated group and delayed treated group was 89.2 (good) and 72.5 (fair), respectively, according to clinical scoring system of Green and O'Brien. The overall clinical score of all cases was 80.8 (good). Two of the 6 cases in the delayed group developed posttraumatic midcarpal arthritis. Mean range of motion (flexion and extension) was 129.5 +/- 20.42 degrees in the early treated group and 95.5 +/- 18.08 degrees in the delayed group. Four of the 6 patients treated in the acute group gained normal grip strength, but 2 patients had more than 50% loss in grip strength compared with the contralateral wrist. Two of the 6 patients in the delayed group had normal grip strength, and 4 patients had more than 50% loss in grip strength compared with the contralateral wrist. The mean grip strength of the normal hands of all patients was 43.75 +/- 7.71 kg. The mean grip strength of the early treated group was 34.00 +/- 12.83 kg, whereas the mean grip strength of the delayed treated group was 26.33 +/- 13.48 kg. Average SL and RL angle in the early postoperative period were 47.5 and -9.40 degrees, respectively. At the last follow-up, average SL and RL angle were 55.5 and 5.43 degrees, respectively. The revised carpal height ratio was 1.51 in the early postoperative period and decreased to 1.45 at the last follow-up.
  
  
  CONCLUSIONS
  We recommend open reduction and internal fixation for early and delayed transscaphoid perilunate fracture-dislocations.
authors.affiliation: Department of Orthopaedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Komurcu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kürklü
authors.forename: Kutay Engin
authors.initials: KE
authors.lastname: Ozturan
authors.forename: Mahir
authors.initials: M
authors.lastname: Mahirogullari
authors.forename: Mustafa
authors.initials: M
authors.lastname: Basbozkurt