Abstract
Aim of the study
End results analysis of operative treatment in transcaphoid perilunate dislocations.
Material and method
From 1/1/91 to 1/1/01 twenty transcaphoid perilunate dislocations were operative treated. Ligamentous lesions were repaired through a dorsal approach, either by directly suturing the ligaments (10cases), or by using mini Mitek anchors (8 cases). Simple approximation and stabilization with K-wires was performed in 2cases. Scaphoid fractures were treated by open reduction and internal osteosynthesis with Herbert screw (12 cases), cortical AO 2.0 screw (2cases) or K-wires (6 cases). The wrist remained immobilized in a slight flexed position with short arm plaster for 8 weeks. Physiotherapy was necessary for all patients to regain full range of motion. Clinical and radiological evaluation was possible for all patients. The end results were estimated according to Cooney’s evaluation system. Kinematics of the injured wrists was also tested by cineradiography in order to estimate the dynamic behaviour of the wrist. The Average follow-up time was 52 months (range 11–76).
Results
Twelve patients had excellent result, 4 good, 1 fair, and 3 poor. Fourteen out of 16 cases returned to their previous work. Additional operations were required in two patients: 1) four corner arthrodesis because of aseptic necrosis of the proximal pole of the scaphoid with arthritic changes, 2) Scaphoid reoperation because of non-union by Matti-Russe procedure. The later was found in cineradiography to present a painless rotational instability.
Conclusions
Transcaphoid perilunate dislocation has a very good response to early operative treatment. Dorsal ligament repair with mite mini anchors seems to be a reliable easy made method. Scaphoid fracture stabilization requires a stable compressive fixation. Herbert screw is ideal and can be safely placed from proximal to distal via the dorsal incision. Cineradiography is the best way to evaluate normal wrist kinematics.
The abstracts were prepared by Mrs Anna Ligocka. Correspondence should be addressed to IX ICL of EFORT Organizing Committee, Department of Orthopaedics, ul. Kopernika 19, 31–501 Krakow, Poland
