AAHS - Evaluating the Impact of Concurrent Trauma on Outcomes After Perilunate Spectrum Injuries

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Evaluating the Impact of Concurrent Trauma on Outcomes After Perilunate Spectrum Injuries
Eric C Mitchell, MD MSc^¹, Kathy Zhang, MD^¹, Matthew WT Curran, MD^², Neil J. White, MD, FRCSC^³; Ruby Grewal, MD, MSc^⁴
(¹)Western University, London, ON, Canada, (²)Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, (³)Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada, (⁴)Hand and Upper Limb Center, Western University, London, ON, Canada

Introduction

Perilunate spectrum injuries (PSIs) are uncommon, but often functionally devastating injuries, typically occurring through high-energy mechanisms. They are characterized by substantial carpal disruption and urgent operative fixation is recommended. Given the frequent high-energy mechanism of injury, concurrent injuries often occur, with reported rates of ranging from 26-52% in the literature (1,2). The impact of concurrent injury on outcomes after a PSI is unclear. Our study hypothesis was that patients with a concurrent injury would have worse outcomes.

Material & Methods

This study consisted of a multi-centre retrospective and prospective analysis of patients who underwent operative intervention for a PSI from 1992 to 2023. Consenting patients with at least one-year followup were included. Data were collected, including demographic and injury-related details and outcome variables including PRWE, QuickDASH, VAS, PROMIS Upper Extremity, PROMIS Physical Function, PROMIS Pain Interference. The primary explanatory variable was the presence of concurrent injuries, excluding minor lacerations or contusions. Statistical analysis was performed using independent t-tests, Chi-Square, ANOVA, and Mann Whitney tests.

Results

Eighty-eight patients met study inclusion criteria with mean follow-up of 9.6±8.5 years. Patient demographics, injury, and operative related details are reported in Table 1. Twenty seven percent of patients had concurrent injuries and 11% of patients required operative intervention for their concurrent injury in addition to their PSI. Table 2 outlines the concurrent injuries that occurred in study patients. Patients with concurrent injuries had significantly worse VAS pain (3.5± .0 vs. 1.8±1.9, p=0.017), PROMIS physical function (46.9±8.8 vs. 53.5±9.6, p=0.007), and PROMIS pain interference scores (54.5±7.6 vs. 50.6±7.8, p=0.013) (Table 3). Patients requiring operative intervention for their concurrent injury did not have significantly worse outcomes compared to those not requiring intervention.

Conclusions

Patients who sustain concurrent injuries along with their PSI may have worse long-term outcomes. Further investigation into which types of concurrent injuries may be more significant and potential confounders is required.

Capo et al. Hand, 2012
Herzberg et al. Journal of Hand Surgery (American), 1993

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