Trans-Scaphoid Perilunate Fracture-Dislocation and Isolated Perilunate Dislocations; Surgical Versus Non Surgical Treatment

Abstract

<br/><span style="font-size: xx-small;">Background: </span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Trans-scaphoid perilunate fracture-dislocation and perilunate dislocations are among uncommon injuries, most commonly seen in young patients due to high energy trauma. The treatment can be achieved either surgically by open reduc</span></span> <br/><span style="font-size: xx-small; font-family: Arial,Arial;">tion and internal fixation or closed reduction and casting.</span> <br/> <br/>Methods: <br/><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">To compare surgical versus non-operative results of treatment of trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocation, we collected the data of 34 patients who were treated at least 5 years before our study, twenty </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">of whom were treated surgically and fourteen were treated nonsurgical. We compared clinical and radiological findings in two </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">groups. Functional outcome was assessed by Mayo wrist score for each patient.</span></span></span> <br/>Results: <br/><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The surgically treated patients had much higher Mayo wrist scores, 85 and 87.78 for perilunate dislocation and trans-scaphoid fracture-dislocation respectively, while 71 and 71.11 in non-surgically treated group respectively. Wrist range </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">of motion was also more favorable in operative group (55 flexion - 54.28 extension for trans-scaphoid fracture-dislocations and 50 flexion, 51.66 extension for perilunate dislocations)than non-operative group(48.5 flexion, 48.1 extension for trans-scaphoid fracture-dislocations and 48.1 flexion, 50 extension for perilunate dislocation). The radiographic changes showed arthritic changes but those changes did not significantly interfered with functional outcome and wrist scores. </span></span></span><br/>Conclusion: <br/><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Regarding our better clinical results after early open reduction and internal fixation for these injuries, we can </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">suggest the operativetreatment of these complicated hand injuries.</span></span></span>