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Management of Perilunate Injuries with SLIC Screw and Early Motion
William Geissler, MD; David Black, MD
University of Mississippi Medical Center, Jackson, MS
Introduction: Perilunate injuries can leave patients weak and stiff even with early appropriate operative treatment. Many surgeons use Kirschner wires (K-wires) to maintain the operative reduction while the scapholunate ligament reconstruction heals. Wires are left in place for a minimum of 8 weeks, and then therapy is begun. The scapholunate inter-carpal (SLIC) screw (Acumed, Hillsboro, Oregon, USA) can be used in lieu of Kirschner wires (K-wires) to maintain anatomic reduction of the scapholunate interval in perilunate injuries. Increased stability and elimination of the need for hardware removal prior to beginning therapy allow patients treated with the SLIC screw to begin therapy earlier than patients treated with percutaneous K-wires.
Purpose: The purpose of this study was to determine whether use of the SLIC screw instead of K-wires in patients with perilunate injuries would allow good function as judged by Mayo wrist score and early return to work.
Methods: An IRB approved retrospective review was performed of consecutive patients with perilunate injuries treated with open or arthroscopic reduction and ligament reconstruction followed by SLIC screw placement over a three-year time period (May 2012 to May 2015). Inclusion criteria were: skeletally mature patients with perilunate injuries classified as minimum Mayfield 1, Geissler Grade III or IV. Exclusion criteria were: less than 3 months follow up, neurologic injury of the ipsilateral upper extremity, and previous injury to the wrist limiting function. Flexion, extension, pain, work status, and grip strength were measured for all patients. Mayo wrist scores were calculated. Descriptive statistics were performed using SPSS version 23.
Results: Twenty-seven patients met inclusion criteria over the study period. Seven patients were excluded. Forty-eight percent of injuries were due to a fall, and 44 percent of injuries were the result of car accidents. Median length of follow up was 4 months (range 3 months to 3 years). Mean flexion was 44 degrees. Mean extension was 37 degrees. Mean Mayo wrist score was 75. Fifty-five percent (11/20) of patients had good or excellent outcomes as determined by Mayo wrist score, thirty-five percent (7/20) had satisfactory outcomes, and ten percent (2/20) had poor outcomes. Ninety percent of patients (18/20) were able to return to work within 3 months. Five patients had secondary procedures: three developed arthritis and required fusion, and two patents had screw removal.
Conclusions: The majority of patients treated with a SLIC screw for perilunate injury had good or excellent outcomes and were able to return to work within 3 months after surgery.
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