Title: Management of Lunate and Perilunate Fracture Dislocation through Isolated Volar Approach: A Case Series of Ten Cases
Authors: Dr Amit Lakhani, Dr S. M.Bhatnagar, Dr Ena Sharma, Dr Jatin Aggarwal
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.70
Abstract
Objective: Lunate and perilunate fracture dislocations are complex injuries. Mayfield, Johnson, and Kilcoyne described four stages of progressive disruption of ligament attachments and anatomical relationships to the lunate resulting from forced wrist hyperextension. Urgent close reduction and pop slab is first line of management5.Unsatisfactory reduction and poor fixation at the same time can lead to poor treatment outcome. There are numerous surgical methods to treat such injuries.
Methods: We describe here a series of ten cases of lunate and perilunate fracture dislocation treated by using single volar approach.
Results: All patients gained full ROM in 6 months. We have longest follow up of 5 years (Fig 5,6) withMAYO15 wrist score 94.
Conclusions: We strongly recommend isolated volar surgical approach for treating these injuries.
Keywords: Volar; dislocation; ROM (Range of Motion); MAYO Wrist Score.
References
- Boyes, 1970. Boyes JH: Bunnell's surgery of the hand,5th ed. Philadelphia, Lippincott, 1970.
- Cooney et al., 1998.In: Cooney WD, Linscheid RL, Dobyns JH, ed. The wrist,St Louis: Mosby; 1998.
- Mayfield, 1980. Mayfield JK:Mechanism of carpal injuries.Clin Orthop Relat Res1980; 149:45.
- Mayfield, 1984. Mayfield JK:Patterns of injury to carpal ligaments: a spectrum.Clin Orthop Relat Res1984; 187:36
- Zhang X1, Wei Q2, Ji F1, Tong DK1, Tang H1, Zhang H1, Yu JG1, Yang JD1, Cui R1, Huo NN1.
- Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation].Zhongguo Gu Shang. 2018 May 25;31(5):441-445. doi: 10.3969/j.issn.1003-0034.2018.05.009.
- Melone CP Jr1, Murphy MS, Raskin KB. Perilunate injuries. Repair by dual dorsal and volar approaches.Hand Clin. 2000 Aug;16(3):439-48.
- Dumontier C, Meyer zu Reckendorf G, Sautet A, Lenoble E, Saffar P, Allieu Y. Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases. J Bone Joint Surg Am. 2001;83-A(2):212–8. [PubMed]
- Grissis P, Christodoulou A, Chalichlis B, Pournaran J. Neglected transscaphoid, transstyloid volar dislocation of lunate. J Bone Joint Surg Br. 2006;88:676–80
- Akinleye SD, Makani A, Dalinka MK, Chang B. Unusual proximal dislocation without fracture: a case report. Hand (N Y). 2012;7(4):454e456
- Dimitriou CG, Chalidis B, Pournaras J. Bilateral volar lunate dislocation. J HandGoodman AD, Harris AP, Gil JA, Park J, Raducha J, Got CJ. Evaluation, Management, and Outcomes of Lunate and Perilunate Dislocations.Orthopedics. 2019 Jan 1;42(1):e1-e6. doi: 10.3928/01477447-20181102-05. Epub 2018 Nov 7.
- Stevanovic M, Schnall SB, Filler BC. Trans-scaphoid, transtriquetral, volar lunate fracture- dislocation of the wrist. J Bone JtSurg Am. 1996;78:1907e1910
- Cohen MS, Kozin SH. Degenerative arthritis of the wrist: Proximal row carpectomy versus scaphoid excision and four corner arthrodesis. J Hand Surg 2001;26:94‑104.
- Rettig ME, Raskin KB. Long term assessment of proximal row carpectomy for chronic perilunate dislocations. J Hand Surg 1999;24:1231‑6.
- Amadio PC1, Berquist TH, Smith DK, Ilstrup DM, Cooney WP 3rd, Linscheid RL. Scaphoid malunion.J Hand Surg Am. 1989 Jul;14(4):679-87.
- Gelberman RH, Gross MS. The vascularity of the wrist: identification of arterial patterns at risk. Clin Orthop Relat Res 1986;202:40–9. [PubMed] [Google Scholar]
- Vasireddy A, Lowdon I. Lunate fracture in an amateur soccer player. J Orthop Sports Phys Ther 2009;39:884. [PubMed] [Google Scholar
- Mamon JF, Tan A, Pyati P, Hecht A. Unusual volar dislocation of the lunate into the distal forearm: case report. J Trauma. 1991;31:1316–8. [PubMed] [Google Scholar]
- Jaiswal A, Kachchhap ND, Tanwar YS, Habib M, Kumar B. Complete palmer lunate enucleation—is proximal row carpectomy or wrist arthrodesis the only choice? Chin J Traumatol. 2013;16:298–300. [PubMed] [Google Scholar]
- Bartonícek J, Dzupa V. Anchor limited arthrodesis of the wrist. Arch Orthop Trauma Surg. 2001;121:102–3. [PubMed] [Google Scholar]
- Draaijers LJ, Kreulen M, Maas M. Palmar dislocation of the lunate bone with complete disruption of all ligaments. A report on two cases. Acta Orthop Belg. 2003;69:452–4.
- Jaiswal A1, Kachchhap ND, Tanwar YS, Habib MComplete palmer lunate enucleation---is proximal row carpectomy or wrist arthrodesis the only choice? Chin J Traumatol. 2013;16(5):298-300.