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February 19, 2016
Contributors: Laura Sims, MD; George S. Athwal, MD; David Sauder, MD; Jason Shin, MD; Jason Shin, MD
Keywords: Bony Procedure
INTRODUCTION: Perilunate injuries represent a severe disruption of the carpal anatomy. Transscaphoid perilunate fracture dislocations involve both ligamentous and bony injuries, and make up the majority of perilunate injuries, at 60%. Twenty-five percent of perilunate injuries are missed at initial presentation. Delay in treatment is an important factor in long-term outcomes. When managed non-operatively, outcomes are universally poor and scaphoid non-union rates are greater than 50%. Early recognition and surgical management with anatomic fixation of both the fracture and the ligamentous injury leads to satisfactory results. The purpose of this video is to highlight the pertinent aspects related to pathoantomy, presentation, and management of transscaphoid perilunate dislocations with an emphasis on surgical technique.
METHODS: This comprehensive video provides an evidence-based review of the pathoanatomy, presentation, initial management, surgical technique, outcomes, and complications of patients with transscaphoid perilunate dislocations. Step-by-step instructions for surgical technique is included, with surgical pearls emphasized.
RESULTS: This video highlights the relevant anatomy, presentation, and surgical techniques related to transscaphoid perilunate fracture dislocation guiding treating clinicians in appropriate management of these complex injuries. Surgical pearls as well as strategies to reduce negative outcomes such as schaphoid non-union, avascular necrosis, dorsal intercalated segment instability, and degenerative arthritis are included. A systematic review of the current literature is performed and presented, in order to inform the viewer of the best available evidence. DISCUSSION: Perilunate injuries are often missed, which can lead to devastating outcomes. Transscaphoid fracture perilunate dislocations make up the majority of these injuries. Early diagnosis and appropriate surgical management are paramount to successful outcomes. This video provides orthopaedic surgeons with a comprehensive framework based on the best-available evidence to assist in making treatment decisions for these patients to optimize outcomes.