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Epidemiology and Patterns of Perilunate Fracture-Dislocations Over a 17 Year Period
Sophia Leung, MD1; W. Andrew Eglseder, MD2; Joshua Abzug, MD1
1University of Maryland Medical Center, Baltimore, MD; 2University of Maryland, Baltimore, MD
Introduction: Perilunate dislocations and fracture-dislocations comprise a spectrum of disruptions to the carpal anatomy. Although the patterns of injury are variable, they are always severe, debilitating, and often difficult to correct surgically. These rare injuries are often all grouped together as one entity. The purpose of this study was to assess all perilunate types by classifying injuries, assessing associated injuries, and looking for trends over time.
Materials and Methods: A 17-year period at a Level I Trauma center was retrospectively reviewed. Injuries were divided into three groups; Group 1 were transscaphoid perilunate injuries, Group 2 were pure ligametous perilunate injuries, and Group 3 included all other perilunate fracture dislocations that involved a fracture to any other carpal bone, distal radius, or ulna. Demographic data and medical history were obtained, as well as injury data.
Results: Between 1991 and 2008, 140 perilunate fracture/dislocations were treated at our Level I trauma center with 131 patients having complete data. There were 117 males and 14 females, with an average age of 37.4 years (range 17-85). Group 1 consisted of 42 patients, Group 2 had 43 patients and Group 3 had 46 patients. 68 patients (48.6%) had a scaphoid fracture as a component of their injury. Amongst the complex fractures, 22 different injury pattern variations were seen, with the most common being trans-radial styloid (n=11), transscaphoid/trans-radial styloid (n=9), transscaphoid/transcapitate (n=6), associated distal radius fracture (n=5), transtriquetral (n=4), and transscaphoid/transtriquetral (n=3). Open fractures were rare, seen in only 4 of 131 cases (3%). Naviculocapitate syndrome was present in 4 cases (3%). Acute median nerve symptoms, including one medial nerve transection, was seen in 20 patients (15.2%). Four patients developed late onset carpal tunnel syndrome (3%). Nineteen patients sustained ipsilateral upper extremity injuries (14.5%), and 50 patients sustained major non-orthopaedic injuries (38.2%). The most common mechanism of injury was fall from height (n=59), followed by motor vehicle collision (n=27), and motorcycle collision (n=22). No significant trends were noted over this period.
Conclusions: Perilunate fracture-dislocations comprise multiple injury patterns with differing treatments required. A perilunate injury associated with a scaphoid fracture is the most common pattern, comprising nearly half of all injuries. However, more than twenty different perilunate injury patterns have been identified, and concomitant ipsilateral upper extremity injuries are not uncommon. Median neuropathy can occur in 15% of patients. Careful physical examination should be undertaken to diagnose acute carpal tunnel syndrome, as it may affect surgical approach.
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