Lack of experience is a signiŞcant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation

Abstract

Objective: The aim of this study was to analyze the risk factors contributing to the misdiagnosis ofperilunate injuries.Methods: The study included patients who had perilunate dislocation or fracture dislocation correctly orincorrectly diagnosed on initial examination between 2008 and 2014. Data related to the length of timeuntil correct diagnosis of the perilunate injury; cause of injury; presence of associated fractures, polytrauma or concomitant trauma in the ipsilateral upper extremity; time between injury andŞrst presentation;Şrst treatment applied; presence of ligamentous perilunar injuries only or fracture and dislocation;inadequate radiographic assessment; and experience of the physicians were recorded and analyzed.Results: A total of 44 wrists were included in the study. Of those, 10 (22.7%) wrists (mean patient age: 44.4years [28± 58 years]) with perilunate injuries were misdiagnosed in the initial evaluation. All of the riskfactors were found to be similar between the group of patients with correct initial diagnosis and misseddiagnosis group, except for the experience of the orthopedic surgeon assessing the injury (p¼ 0.0001). Of thesurgeons who missed the diagnosis, 70% reported that it was theirŞrst encounter with a perilunate injury.Conclusion: The results of this study indicated that lack of experience was the most important factor inthe misdiagnosis of perilunate fracture dislocation or isolated dislocation. Level of Evidence: Level IV,diagnostic study.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).