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Adolescent Perilunate Dislocations: Etiology, Management, and Outcomes
Vamsi C Mohan, MD
1, John D Bovill, MD
2, Samuel H Cole, MD
3, Benjamin Belfort, MD, Jenny Lee Nguyen, MD; William C Pederson, MD
2(1)Texas Children's Hospital, Houston, TX, (2)Baylor College of Medicine, Houston, TX, (3)Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
Background: Perilunate dislocations are severe injuries that occur in the setting of high-energy trauma. These injuries are uncommon in adults and even more so in the pediatric population, with very few studies depicting their occurrence.
1-5 Here, we present the management and outcomes of patients with perilunate dislocations at a single large academic pediatric institution.
Patients and Methods: A retrospective chart review was conducted of all patients younger than 18 years of age from 2011 to 2024 presenting with perilunate dislocations. Variables analyzed included age, sex, mechanism of injury, time to treatment, operative interventions, postoperative function, and scapholunate angles.
Results: Seven patients were identified with perilunate dislocations over the 14 year period. Six patients were male, and the average age was 16 years (range: 15 to 17 years). Mechanisms of injury included football, basketball, skiing, weight lifting, falls, and a motorcycle accident. Patients were diagnosed with either a perilunate dislocation (n=4), transradial/transscaphoid perilunate fracture dislocation (n=2), or transscaphoid perilunate fracture dislocation (n=1), with additional injuries including thumb metacarpal fracture and ulnar styloid avulsion fracture. Six patients had symptoms of acute carpal tunnel syndrome on presentation. Definitive surgical repair occurred 8 days from the date of injury on average (range: 1 to 24 days). All seven patients underwent open treatment of the perilunate dislocation (dorsal approach in five, dorsal and volar approach in two), six required carpal tunnel release, five required lunotriquetral ligament repair, four required scapholunate ligament (SL) repair, and one patient received a posterior interosseous nerve neurectomy. The average follow-up time was 20.6 weeks (range: 12 to 44 weeks). Average degree of active wrist flexion and extension at the final follow-up visit was 32.9 (range: 0-50 degrees) and 51 (range: 30 to 60 degrees), respectively. The average SL angle at the final follow-up was 41.2 degrees (range: 37 to 62 degrees). All patients reported no pain at the most recent clinic visit and returned to full pre-injury activity including football and cheerleading.
Conclusions: Perilunate dislocations present with acute carpal tunnel syndrome necessitating early operative intervention involving carpel tunnel release and open surgical repair. From our experience, adolescent patients are able to return to pre-injury function after appropriate surgical treatment. As future studies continue to provide insight on these injuries within this population, long-term outcomes can be further detailed and a treatment algorithm to restore optimal function can be created.
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