Surgical outcomes of trans-scaphoid perilunate fracture-dislocations.

1.

BACKGROUND AND AIM: Trans-scaphoid perilunate fracture-dislocation (TSPFD) is a rare injury. TSPFD is a fracture-dislocation that severely disrupts the anatomical structure of the carpal bones and may occur as a result of a high energy wrist trauma or fall on an open hand. In this study, the aim was to provide midterm clinical and radiological evaluations of cases diagnosed and treated as TSPFD. 2.

PATIENTS AND METHODS: 11 cases diagnosed as TSPFD as a result of wrist trauma were treated surgically were analyzed retrospectively. Clinical and radiological follow-up of the cases was evaluated. The average age of the patient was 34 years. All of the cases were male patients with a dorsal dislocation according to Herzberg?s perilunate fracture-dislocation classification. The average follow-up time was 33 months. All of the cases were evaluated with preoperative and postoperative standard wrist anteroposterior and lateral radiographs. A dorsal approach was used in all cases; however, in 1 case a volar approach was also required. The Green and O?Brien evaluation scale modified by Cooney was used for clinical assessment of pain, wrist range of motion, grip strength, and functional status as excellent, good, moderate, or poor. The wrist range of motion was evaluated goniometrically at the final check-up, and a mid-grade disability was observed compared with the uninjured side. The visual analog scale was used to evaluate pain. 3.

RESULTS: Sufficient union was obtained in all cases with open reduction and internal fixation of the fractures. Grip strength was 77.5% compared with the other side. According to the modified Green and O'Brien clinical evaluation scale, 6 cases were evaluated as good, 3 cases were fair, and 2 cases were poor. No median nerve damage was determined preoperatively or postoperatively and there was no postoperative pin tract infection in any patient. 4.

CONCLUSION: This kind of injury represents complex, biomechanical damage of the wrist anatomy. If it is diagnosed early and treated with open reduction-stable fixation, a functionally adequate and anatomically integrated wrist can be achieved.