The surgical outcomes of trans-scaphoid perilunate fracture-dislocations

Abstract

Background/aim: Trans-scaphoid perilunate fracture-dislocation (TSPFD) is a rare injury. TSPFD is a fracture-dislocation that severelydisrupts the anatomical structure of the carpal bones and may occur as a result of a high energy trauma of the wrist or a fall on an openhand. In this study, the aim is to provide midterm clinical and radiological evaluations of cases diagnosed and treated as TSPFD.Materials and methods: Eleven patients diagnosed with TSPFD as a result of wrist trauma were treated surgically and were analysedretrospectively. Clinical and radiological follow-up of the cases was evaluated. The mean age of the patients was 34 years. All patientswere males with a dorsal dislocation according to Herzberg’s perilunate fracture-dislocation classification. The mean follow-up time was33 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 scalemodified by Cooney was used for the 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 wasobserved compared with the uninjured side. A visual analogue scale was used to evaluate the pain.Results: Sufficient union was obtained in all cases with open reduction and internal fixation of the fractures. Grip strength was upto 77.5% of the other side. According to the modified Green and O’Brien clinical evaluation scale, 6 cases were evaluated as good, 3cases were fair, and 2 cases were poor. No median nerve damage was determined preoperatively or postoperatively and there was nopostoperative pin tract infection in any of the patients.Conclusion: This kind of injury represents complex biomechanical damage of the wrist anatomy. If it is diagnosed early and treated withopen reduction and stable fixation, a functionally adequate and anatomically integrated wrist can be achieved.