Perilunate dislocations/fracture dislocations (PLD/PLFDs) are uncommon high-energy injuries resulting in significant morbidity. We aimed in a retrospective study, to examine the frequency and appearance of median nerve neuropathy following PLD/PLFDs sequalae.
Patients & Methods:
Retrospectively, we identified 21 wrists-2 bilateral, who had sustained a PLD/PLFD over a 10-year period, and had a follow up >6months. Mean age was 41 years (18-61). 17/19 were men. Through patient records, we aimed for: median neuropathy symptoms in pre-, post-reduction and post-surgery period, carpal tunnel release, and associated injury characteristics. All patients had an initial closed reduction followed by surgical treatment. A dorsal approach was performed for fixation of carpal fractures and repair of scapho-lunate ligament. A volar approach was used to repair the capsular rent and decompression of the median nerves were needed. Time to reduction and to surgery were recorded. During follow-up examination, patients were recorded to have median neuropathy with at least 2 symptoms (thenar atrophy, sensory disturbance, oppositional weakness, Tinel sign, pathological findings in electrophysiology studies). Patients with and without median neuropathy were compared. Parameters as: DASH score, VAS pain scale, Mayo wrist score, wrist motion and grip strength were used for assessment.
Results:
Acute median neuropathy before reduction was present in 9/21 wrists (42,88%) and post-reduction in 11/21 (52.38%). Carpal tunnel release was performed in 12/21 (57,14%) wrists, during initial surgery. In 3/12 CTRs, the median nerve was regarded as contused. Another 2/9 (22.22%) wrists with delayed median neuropathy required CTR during follow-up. Patients with median neuropathy (11/21 wrists) had a worse result compared to those without (10/21 wrists) in regards to grip force, DASH, and Mayo scores).
Conclusion:
Although, several limitations exist in our study, we believe that acute median neuropathy in PLD/PLFDs injuries has a high incidence and needs clinical awareness throughout the FU period. Reduction does not really improve the number of wrists with acute neuropathy.
