Abstract
Twenty-two consecutive patients (23 wrists) underwent open reduction internal fixation
of dorsal perilunate dislocations and fracture-dislocations through combined dorsal
and volar approaches. One of 5 experienced wrist surgeons performed these procedures
within an average of 3 days of injury (range, 0-26 days) and intercarpal fixation
was kept within the proximal carpal row. Motion was instituted an average of 10 weeks
(range, 5-16 weeks) after injury. All patients were males. The average age at the
time of injury was 32 years (range, 16-60 years). The average follow-up period was
37 months (range, 13-65 months). Average flexion-extension motion arc and grip strength
in the injured wrist were 57% and 73%, respectively, compared with the contralateral
wrist. The scapholunate angle increased and the revised carpal height ratio decreased
over time, which was statistically significant for both measurements. Three patients
(3 wrists) required wrist arthrodesis and a fourth patient had an immediate scaphoid
excision and 4-corner arthrodesis secondary to an irreparable scaphoid fracture. One
patient required a proximal row carpectomy to treat septic arthritis. Nine of the
remaining 18 wrists had radiographic evidence of arthritis, most often at the capitolunate
or scaphocapitate articulations. Short form-36 mental summary scores were significantly
greater than age- and gender-matched US population values; physical summary scores
were significantly less. The disabilities of arm, shoulder, and hand evaluation, Mayo
wrist score, and patient-rated wrist evaluation all reflected loss of function. Seventy-three
percent of all patients had returned to full duties in their usual occupations and
a total of 82% were employed. (J Hand Surg 2000;25A:1069-1079. Copyright © 2000 by
the American Society for Surgery of the Hand.)
Keywords
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Article info
Publication history
Accepted:
June 1,
2000
Received:
November 29,
1999
Footnotes
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
**Reprint requests: Kevin A. Hildebrand, MD, Department of Surgery, University of Calgary, 3330 Hospital Dr NW, Calgary, AB Canada T2N 4N1.
Identification
Copyright
© 2000 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
