The authors reviewed a series of 14 trans-scaphoid dorsal perilunate fracture-dislocations treated operatively at an average of 6 days following injury. Thirteen patients underwent open reduction and internal fixation, 11 through a dorsal approach and 2 through combined dorsal and palmar incisions. One patient was treated with a proximal row carpectomy. At a mean follow-up of 103 months (range, 40 ? 160 months) Mayo wrist scores averaged 79 points (range, 55 ? 95 points); grip strength measurements averaged 79% of the opposite side; and mean wrist flexion-extension arcs measured 112 degrees. The two wrists addressed with combined dorsal and palmar approaches had flexion-extension arcs of only 70 and 75 degrees, respectively. Post-traumatic arthritic changes involving the radiocarpal and midcarpal intervals were detected radiographically in nearly all cases.
Previous reports of operatively treated trans-scaphoid dorsal perilunate fracture-dislocations using combined dorsal and palmar approaches have included Mayo wrist scores comparable to this study (Cooney et al, CORR 214:136-47, 1987; Sotereanos et al, JHS 22A:49-56, 1997). However, the mean wrist flexion-extension arcs have been comparatively less. The authors of this study hypothesized that a combined dorsal and palmar approach may lead to more wrist stiffness than a single dorsal exposure. None of the patients in this series underwent repair of torn intrinsic or extrinsic carpal ligaments.
Journal of Hand Surg