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American Association for Hand Surgery

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Outcomes of Acute Proximal Row Carpectomy versus Open Reduction and Internal Fixation for Perilunate Injuries
Keith T Aziz, MD1, Daniel A London, MD, MS2, Phil Ross, MD1 and Peter J Stern, MD1, (1)University of Cincinnati, Cincinnati, OH, (2)Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Perilunate dislocations are challenging and rare injuries. Even with surgical intervention, there is a high incidence (67%-100%) of post-traumatic arthritis. Recently there has been some consideration to treat perilunate dislocations with acute proximal row carpectomy (PRC), though the optimal management for perilunate dislocations is not known. The purpose of this study is to compare the outcomes of acute PRC to open reduction and internal fixation (ORIF) in patients with perilunate dislocation

Materials & Methods: We performed a retrospective review of all patients treated at a level 1 trauma center between 2008 and 2020. Patients were identified by both Current Procedural Terminology (CPT) code and International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification (ICD-9-CM and ICD 10-CM) codes. We then performed a thorough review of the medical record, recording complication profile, injury mechanism, and used the last available clinical evaluation for range of motion and VAS pain scores for clinical outcome data. Demographic, outcomes, and complication data were compared between groups using t-tests for continuous variables and chi-square tests for categorical variables.

Results: We identified 37 patients with perilunate dislocations, 8 patients underwent acute PRC and 29 patients underwent ORIF. Patients who underwent PRC were younger than patients who underwent ORIF (54 vs 39 years, p < 0.01). Patients who underwent ORIF were significantly more likely to require return to the OR (83% vs 135%, p<0.01). There was no significant difference in the final VAS (3.7 vs 3.5) , total arc of wrist motion (59o vs. 58.5o), or complication rate (38% vs. 45%) of patients who underwent PRC compared to those who underwent ORIF. The average final follow up was 1.1 years.

Conclusion: When compared to patients undergoing acute PRC for perilunate dislocation, patients who underwent ORIF had a significantly higher rate of secondary surgery. There was no difference in complication rate or acute clinical outcomes when comparing patients treated with acute PRC to patients treated with ORIF for perilunate dislocation.

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