title: Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors.
abstract: BACKGROUND
  Perilunate injuries are rare entities which can be difficult to diagnose. Most common type is dorsal perilunate fracture dislocation (97%). The purpose of treatment is anatomic reduction and stable fixation. We aimed to present the radiologic and functional results of surgically treated dorsal perilunate fracture-dislocations and discuss the factors influencing the prognosis.
  
  
  METHODS
  Between 2007 and 2013, 17 patients were operated for perilunate fracture-dislocations. The mechanism of injuries, soft tissue traumas, etiologic factors and stages according to Herzberg classification were determined. The MAYO wrist score was used for functional evaluation. Scapholunate distance and scapholunate angle were measured and, degenerative changes were investigated by comparing with contralateral side on plain x-ray images in terms of radiologic evaluation.
  
  
  RESULTS
  Mean follow-up was 37,8 (range, 16-84) months. The average age at surgery was 35.1 (range, 18-51) years. Fifteen patients were male and two were female. Functional results were excellent in four (23.5%), good in two (11.8%), satisfactory in five (29.4%) and poor in six (35.3%) patients. Degenerative changes were determined in radiocarpal and mid-carpal joints of 14 wrists (82.4%). Scapholunate dissociation more than 2 mm was detected in three wrists. In four wrists osteochondral fragments were determined on the head of the capitate. Stage 2 lesions, delayed presentations, open fractures, scapholunate dissociations more than 2 mm had worse functional results.
  
  
  CONCLUSIONS
  Despite anatomic reduction, ligamentous and chondral injuries that occured at the time of trauma may cause persistant wrist pain in patients who suffer perilunate fracture dislocation. Mechanism of injury, presence of soft tissue defects and the time between injury and treatment can affect clinical and radiologic results.
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Goztepe, Metin Sk. No: 4, 34214 Bagcılar, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kara
authors.affiliation: Department of Orthopaedics and Traumatology, Zonguldak Ataturk State Hospital, Mesrutiyet Mahallesi Huzur Sokak No:35, 67030, Zonguldak, Turkey. Electronic address: drhalukcelik@gmail.com.
authors.forename: Haluk
authors.initials: H
authors.lastname: Celik
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Goztepe, Metin Sk. No:4, 34214 Bagcılar, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Seker
authors.affiliation: Department of Orthopaedics and Traumatology, Igdir State Hospital Kisla Mh., 76000 Igdir, Turkey.
authors.forename: Eray
authors.initials: E
authors.lastname: Kilinc
authors.affiliation: Department of Orthopaedics and Traumatology, International Hospital, Istanbul Cad. No: 82, Yesilkoy, 34030 İstanbul, Turkey.
authors.forename: Savas
authors.initials: S
authors.lastname: Camur
authors.affiliation: Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, Darussafaka Mh., Buyukdere Cad. No: 40 Maslak, 34457 Sariyer, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Uzun
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery*; D012667:Lunate Bone / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013997:Time Factors; D014954:Wrist Injuries / Q000601:surgery*; D055815:Young Adult
keywords: Dorsal perilunate fracture-dislocation; Perilunate fracture-dislocation; Prognostic factors; Surgical treatment