Perilunate injuries are rare carpal dislocations, and standard management involves urgent or emergent reduction to restore anatomy and alleviate nerve compression. We hypothesized patients undergoing earlier reduction would have improved postoperative patient-reported outcomes compared to those undergoing later reduction.
Materials & Methods
This study consisted of a multi-centre retrospective and prospective analysis of patients who underwent operative intervention for a perilunate injury from 1992 to 2023. Consenting patients with at least one-year followup were included. Patients who did not speak English were excluded. Data were collected on 81 subjects, including demographic and injury-related details and outcome variables including PRWE, QuickDASH, VAS, PROMIS Upper Extremity, PROMIS Physical Function (PF), PROMIS Pain. The primary variable was days to reduction from injury (earliest of either successful closed reduction preoperatively or definitive operative reduction), which we dichotomized as reduction on same day of injury (day 0) versus ?1 days from injury. We fit linear regression models predicting the outcome variable adjusted for age and sex. For purposes of regression modeling, PRWE, QuickDASH, and VAS were log-transformed in order to normalize the residuals. Analyses were performed using SAS v9.4.
Results
Patient demographics and injury related details are reported in Figure 1. Median days to reduction was 1.0 (IQR 0.7-3.1, range 0-40). Seventeen patients were reduced on the same day as their injury and 63 patients were reduced ?1 days from injury. PROMIS Pain scores were significantly higher for those reduced on day 0 versus ?1 days from injury (55.5±7.8 vs 50.3±7.9, p=0.025). PROMIS PF scores were borderline significantly lower for those reduced on day 0 versus ?1 days from injury (48.1±9.5 vs 53.0±9.8, p=0.053). In the regression model, there was a significant effect of reduction on day 0 versus ?1 days from injury for PROMIS Pain when adjusted for age and sex (?=4.68, p=0.040).
Conclusions
Perilunate injury patients who underwent reduction on the same day as their injury had significantly worse PROMIS Pain scores compared to those reduced ?1 days after injury, with no significant differences in other evaluated outcomes. This finding is contrary to our hypothesis and warrants an increase in sample size as well as investigation into potential results confounders including presence of additional traumatic injuries requiring operative intervention, injury severity, and experience of operating surgeon.
