title: Comparative Outcome Analysis of Arthroscopic-Assisted Versus Open Reduction and Fixation of Trans-scaphoid Perilunate Fracture Dislocations.
abstract: OBJECTIVE
  To compare union rates and clinical and radiological outcomes of arthroscopic-assisted reduction and fixation with those of open reduction and fixation in patients with trans-scaphoid perilunate fracture dislocations.
  
  
  METHODS
  This retrospective study included consecutive patients with trans-scaphoid PLFDs who underwent arthroscopic-assisted reduction and fixation (group A) or open reduction and fixation (group O), and who were followed up for a minimum of 2 years between May 2005 and March 2013. We excluded initially missed patients. Each different surgeon who was on call had performed each experienced operation. These clinical outcomes were assessed: range of motion, grip strength, Mayo wrist score, and Disabilities of Arm, Shoulder, and Hand (DASH) score. For radiologic outcomes, the scapholunate angle, radiolunate angle, and lunotriquetral distance were measured.
  
  
  RESULTS
  The total number of included patient was 20 (11 in group A and 9 in group O). Scaphoid union occurred in all patients except 1 individual (11 of 11 in group A, and 8 of 9 in group O). At the last follow-up, the mean flexion-extension arc was significantly greater in group A (125.0°) than in group O (105.6°) (P = .028). The mean grip strength was 81.1% that of the contralateral side in group A and 80.9% in group O (P = .594). The mean Mayo wrist score was 85.5 in group A and 79.4 in group O (P = .026), and the mean DASH score was 10.6 in group A and 20.8 in group O (P = .001); however, only the DASH score showed a minimum clinically important difference. The mean scapholunate angle, radiolunate angle, and lunotriquetral distance were similar between the 2 groups: 47.2°, 1.7°, and 2.0 mm in group A and 48.8°, 5.6°, and 2.1 mm in group O, respectively.
  
  
  CONCLUSIONS
  Although both arthroscopic and open techniques achieved stability of the injured wrists in patients with trans-scaphoid PLFDs, it is shown that the arthroscopic-assisted technique showed a clinically meaningful better DASH score and greater flexion-extension arc with other parameters being similar.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Won-Taek
authors.initials: WT
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: YRCHOI@yuhs.ac.
authors.forename: Yun-Rak
authors.initials: YR
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ho-Jung
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Il-Hyun
authors.initials: IH
authors.lastname: Koh
authors.affiliation: Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Han
authors.initials: KH
authors.lastname: Lim
mesh_terms: D000328:Adult; D001182:Arthroscopy; D005260:Female; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D012667:Lunate Bone / Q000293:injuries* / Q000601:surgery; D008297:Male; D000070799:Open Fracture Reduction; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult