The functional results of treatment of perilunate dislocations with volar approach and K-wires fixation
Hakan Başar, İsmail Ağır, Osman Mert Topkar, Cihangir Tetik.
Abstract
Objectives: We evaluated the functional results of traumatic perilunate dislocations treated with volar surgical approach and K-wire fixation technique.
Methods: The study included 4 patients who were operated for perilunate dislocation since 5 years (range 6 to 60 months ) ago. The patients underwent open reduction and internal fixation with K-wire (size 1.5 mm) and K-wire was taken out at 6 th week.Clinical and radiological evaluations were made with use of Dash score, modified Mayo elbow score, VAS score, restart work, patient pleasure, wrist range of motion, hand grip power and post surgical radiologic scapho-lunate angle and gap at 6th months control.
Results: The K-wires were taken at 6th week and than active-pasive wrist range of motion exergices were started at physical rehabilitation
centers. At 6th months controls the mean flexion-extansion arc was 100° and %78 compared with the other wrist, the mean rotation arc was 140° and %81 to the other side, the mean radioulnar arc was 60° and %88.8 to the other side. The grip strength was 0.52 bar and %87.6 that of the uninjured arm. According to the Mayo modified wrist score, the functional result was excellent in 2 patients and good in 2 patients.The mean VAS score was 8.5 pre-operative and 2 was post-operative. According to clinical and radiologic evaluations the mean DASH score was 36, scapho-lunate interval was 2.0 mm, and scapho-lunate angle was 53°.
Conclusion: Perilunate dislocations are rare and severe wrist injuries. Acute perilunate dislocations are usually relatively easy to reduce however carpal collaps and post-travmatic arthritis are seen usually during late period.Because of this open reduction and internal fixation technique is used to prevent carpal collaps and post-travmatic arthritis and to facilitate anatomic reduction.Our results show that open reduction and internal fixation with K-wire can restore affectively normal carpal relationship, providing acceptable grip strength and functional motion,also carpal collaps and post-travmatic arthritis were prevented.
Key words: Kirshner wire, open reduction, perilunate dislocation
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