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Transscaphoid Perilunate Dislocation: Overview and Surgical Technique

February 19, 2016

Contributors: Laura Sims, MD; George S. Athwal, MD; David Sauder, MD; Jason Shin, MD; Jason Shin, MD

Keywords: Bony Procedure

2016 AWARD WINNER Introduction: Perilunate injuries represent a severe disruption of the carpal anatomy. Transscaphoid perilunate fracture dislocations involve ligamentous and bony injuries and account for 60% of all perilunate injuries. Twenty-five percent of perilunate injuries are missed on initial presentation. Delayed management is an important factor that affects long-term outcomes. Nonsurgical management of transscaphoid perilunate injuries results in universally poor outcomes and scaphoid nonunion rates higher than 50%. Early recognition and surgical management via anatomic fixation of the fracture and the ligamentous injury leads to satisfactory results. This video highlights pertinent aspects related to the pathoantomy, presentation, and management of transscaphoid perilunate dislocations, with an emphasis on surgical technique. Methods: This video provides an evidence-based review of the pathoanatomy, presentation, initial management, surgical technique, outcomes, and complications of transscaphoid perilunate dislocations. Step-by-step instructions for the surgical technique are described, with surgical pearls emphasized. Results: The video highlights the relevant anatomy, presentation, and surgical techniques related to transscaphoid perilunate fracture-dislocations, guiding appropriate management of these complex injuries. Surgical pearls and strategies to decrease negative outcomes, such as scaphoid nonunion, osteonecrosis, dorsal intercalated segment instability, and degenerative arthritis, are discussed. A systematic review of the current literature is presented to provide the viewer with the best-available evidence. Discussion: Perilunate injuries often are missed on initial presentation, which may lead to devastating outcomes. Transscaphoid perilunate fracture-dislocations account for most perilunate 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 aid in making treatment decisions for and optimizing the outcomes of patients with a transscaphoid perilunate fracture-dislocation.