title: Peri-lunate dislocation and fracture-dislocation of the wrist: Retrospective evaluation of 65 cases.
abstract: Peri-lunate wrist dislocations and fracture-dislocations are related to high-energy trauma. Prognosis is often compromised because of the complexity of the lesions. The purpose of this study was to assess outcomes of acute peri-lunate injuries and correlate them with the type of lesion and management.
  
  
  
  A monocenter retrospective study has been conducted. Sixty-five patients (65 wrists) were reviewed. According to Herzberg's classification, there were 18 isolated peri-lunate dislocations and 47 peri-lunate fracture-dislocations - 27 with a scaphoid fracture and 20 with an intact scaphoid. The displacement was dorsal in 62 cases. All patients were treated surgically.
  
  
  
  At an average follow-up of 8 years (2-16) the average Cooney score was 66 points, quick-DASH score 21 points, and PRWE score 28 points. Pain score was 1.3 out of 10 points at rest and 4.3 out of 10 with effort. The flexion-extension arc was 96° with an average strength of 38kg (70±23% of opposite side). Radiographic analysis has shown decrease in carpal height, increase in ulnar translation, and DISI. Sign of wrist arthritis was found in 58.5% of the cases. The rate of osteonecrosis was 7.7%. Regional sympathetic painful syndrome was observed in 12%. In 26% of the cases a secondary surgery was needed. No influence has been found with the final results between fracture-dislocation and isolated dislocation, and delay of treatment. Osteochondral lesions observed at surgery (P=0.035), osteonecrosis at follow-up (P=0.017), and modification of the scapho-lunate angle (P=0.029) were correlated with the occurrence of osteoarthritis.
  
  
  
  Peri-lunate dislocation and fracture-dislocation represent severe wrist trauma with often numerous sequelae with follow-up: pain, stiffness, loss of strength, carpal instability and arthritis. Early diagnosis and anatomic reduction are prerequisite to a satisfactory functional result. Capsulo-ligamentous lesions must be repaired and fractures must be fixed.
  
  
  
  Therapeutic IV.
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Israel
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Delclaux
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: André
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Apredoaei
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Rongières
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Bonnevialle
authors.affiliation: Département d'Orthopédie et Traumatologie-Urgences Mains, Hôpital Pierre-Paul Riquet, Hôpital Universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France. Electronic address: mansat.p@chu-toulouse.fr.
authors.forename: P
authors.initials: P
authors.lastname: Mansat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D000072039:Fracture Dislocation / Q000150:complications / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D012667:Lunate Bone; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000209:etiology; D011379:Prognosis; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery*; D014954:Wrist Injuries / Q000150:complications / Q000601:surgery*; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Dislocation; Osteoarthritis; Peri-lunate; Scaphoid; Wrist