Acute and delayed trans-radial perilunate dislocations: open reduction and internal fixation

Objective: To assess hand function after open reduction of acute and delayed perilunate dislocations. Methods: Seven patients (5 men) with perilunate dislocations were treated with open reduction and internal fixation. The injuries included 2 dorsal trans-radial perilunate dislocations, 4 trans-radial styloid perilunate dislocations, and one combined dorsal and styloid trans-radial dislocations. Open reduction, internal fixation with K wires or cannulated screws, ligament repair, and external fixation using plaster were employed. The average follow-up period was 18 months (range, 10-26). The patients were evaluated according to a Mayo wrist score. Results: We obtained 2 excellent results, 3 good, and 2 fair, according to the Mayo wrist score. The mean active range of flexionextension was 109.4°. The mean grip strength of the injured wrist was 84.2%, compared with the contralateral side. Misdiagnose existed in 3 of 7 patients (42.9%). The early treatment group included 2 excellent results and 2 good, while 1 good result and 2 fair were obtained in delay treatment group. Four patients in early treatment group were free of pain, while two patients reported moderate pain and one developed aseptic necrosis of the lunate in delay treatment group. None of the patients experienced nonunion or post-traumatic arthritis. Conclusions: Open reduction and internal fixation can be used to achieve good results and prognosis in cases with both acute and delayed perilunate dislocations.