title: [Stabilization of perilunate and transscaphoid perilunate fracture-dislocations via a combined palmar and dorsal approach].
abstract: OBJECTIVE
  Restoration of the intercarpal alignment and the radio- and ulnocarpal joint in order to avoid the development of a carpal collapse with concomitant arthritis of the radiocarpal and midcarpal joint.
  
  
  METHODS
  All perilunate and transscaphoid perilunate fracture-dislocations. An exception is a pure ligamentous injury with anatomic carpal alignment following closed reduction (computed tomography scan).
  
  
  METHODS
  General contraindications to an operative procedure.
  
  
  METHODS
  It is crucial that all involved bony and ligamentous structures are addressed, using a bilateral approach. Depending on their location, scaphoid fractures are stabilized from proximal or distal, and bony avulsions are fixed at their origin. The typical rent across the palmar ligaments is closed, and the avulsed scapholunate ligament and the dorsal intercarpal ligament are reattached to the adjacent bones. Temporary Kirschner wire fixation is essential for healing.
  
  
  METHODS
  Forearm plaster cast with short thumb for 12 weeks. Kirschner wire removal after 8 weeks.
  
  
  RESULTS
  25 patients (15 perilunate dislocations and ten perilunate fracture-dislocations) could be included for follow-up 5 years after the trauma. Perilunate fracture-dislocations achieved slightly better results than perilunate dislocations. The DASH Score (Disability of the Arm, Shoulder and Hand) averaged 11.3 and 14.2 points, the PRWE Score (Patient- Related Wrist Evaluation) 20.7 and 27.7 points, respectively. The Mayo Wrist Score amounted to 81.5 and 82.7 points. Active range of wrist motion was reduced by one third compared with the opposite side. Grip strength was reduced by 15-20%. The pain level ranged between 2 and 4 on a scale from 0 to 10. In pure ligamentous injuries, degenerative arthritis was more common in the midcarpal joint, whereas radiocarpal arthritis predominated in the fracture-dislocation group.
authors.affiliation: Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Innsbruck, Osterreich. martin.lutz@uki.at
authors.forename: Martin
authors.initials: M
authors.lastname: Lutz
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Christian
authors.initials: C
authors.lastname: Kammerlander
authors.forename: Markus
authors.initials: M
authors.lastname: Gabl
authors.forename: Sigurd
authors.initials: S
authors.lastname: Pechlaner
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008022:Ligaments / Q000293:injuries / Q000601:surgery; D012667:Lunate Bone / Q000293:injuries* / Q000601:surgery*; D008297:Male; D012540:Scapula / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery