Open reduction for perilunate injuries--clinical outcome and patient satisfaction.
OBJECTIVE
Perilunate injuries cause severe carpal malalignment. Open reduction and internal fixation of these injuries has become the treatment of choice. This study evaluated clinical outcome and the patients' perception of disability in activities of daily living after open reduction, ligament reconstruction, and/or internal fixation of the scaphoid. In addition, potential prognostic factors for functional outcome and individual perceptions of disability were analyzed and compared with radiologic findings.


METHODS
This study consisted of a retrospective analysis of patients with perilunate dislocations or fracture dislocations (Mayfield stage 3/4) who were treated in a single institution from 1995 to 2004. Evaluation focused on postoperative radiologic results, range of motion, pain, sensitivity, grip strength, Mayo and Krimmer wrist scores, arthrosis, and the patients' disability in performing activities of daily living (according to the Disabilities of the Arm, Shoulder, and Hand score).


RESULTS
Of the 72 patients treated in the study period, 39 patients (all men) were available for complete follow-up (average, 65.5 mo). Thirty injuries were fracture dislocations; the dominant hand was injured in 14 cases. Normal scapholunate (SL) angles and Gilula arcs were achieved intraoperatively in 34 and 25 cases, respectively. At follow-up, 18 patients had larger than normal SL angles, and 6 patients had ulnar shifting of the carpus. Twenty patients were diagnosed with radiocarpal arthrosis. According to the Visual Analog Scale, pain was 1.8 at rest and 4.8 with activities. Average extension/flexion was 77°; radial/ulnar abduction was reduced to 42°. Average grip strength was reduced to an average of 36.6 kg (compared with 51.6 kg on the opposite side). Twenty-seven patients returned to their former occupations. Average Mayo and Krimmer wrist scores were both 70. The average Disabilities of the Arm, Shoulder, and Hand score was 23.


CONCLUSIONS
Satisfactory results can be achieved with open reduction for perilunate injuries. However, despite this treatment, loss of reduction and arthrosis are frequent findings. Radiologic results do not necessarily correlate with functional outcome; high patient satisfaction was observed in this study.


METHODS
Therapeutic IV.
Kremer
Thomas
T
Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, The University of Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen, Germany. kremer@bgu-ludwigshafen.de
Wendt
Michael
M
Riedel
Kathrin
K
Sauerbier
Michael
M
Germann
Guenter
G
Bickert
Berthold
B
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*