title: Open perilunate injury with lunate revascularization after complete ligamentous avulsion.
abstract: Perilunate dislocations are a devastating injury to the carpus that carry a guarded long-term prognosis. Mayfield type 4 perilunate dislocations are rare, high-energy injuries that carry a risk for avascular necrosis (AVN) of the lunate. When AVN ensues and the carpus collapses, primary treatment with a proximal row carpectomy or arthrodesis has been advocated. This case reports a successful clinical result and revascularization of an extruded lunate with open reduction and internal fixation. This type 4, Gustilo grade 1 open perilunate dislocation exhibited complete avulsion of all lunate ligamentous attachments. Management included open reduction and internal fixation as well as carpal tunnel release through a combined dorsal and volar approach. Despite concerns for lunate AVN due to complete disruption of lunate vascularity, a 10-month postoperative clinical and radiographic examination demonstrated no pain with activities of daily living as well as a revascularized lunate.
authors.affiliation: Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA arangodi@einstein.edu.
authors.forename: Dillon
authors.initials: D
authors.lastname: Arango
authors.affiliation: Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Tiedeken
authors.affiliation: Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Ayzenberg
authors.affiliation: Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Raphael