Arthroscopic management of perilunate fracture dislocations avoids cartilage damage
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Arthroscopically assisted management of perilunate fracture dislocations helps surgeons reduce the dislocation without causing cartilage damage, a presenter said.
At the American Society for Surgery of the Hand Annual Meeting, Bo Liu, MD, FRCS, of the department of hand surgery at Beijing Ji Shui Tan Hospital in Beijing, China, discussed the algorithm he uses in cases of perilunate fracture dislocation injuries.
“The algorithm for treatment of perilunate dislocation is we try a single attempt for closed reduction,” Liu said, noting the closed reduction is often done in the ED. “If closed reduction failed, we will proceed to arthroscopic-assisted reduction ... to avoid repeated forceful closed reduction.”
He said another option to treat these injuries may be early open surgery performed either with a dorsal or volar approach or a combined approach that can address the scaphoid fracture, ligament and capsule.
“The prognosis of this injury is relatively poor and the patient usually has a longer rehabilitation time. So, open surgery is not ideal. The capsular scarring is linked to stiffness and also there is a chance of damage to [the] already tenuous blood supply to the scaphoid and torn ligaments,” Liu said.
Arthroscopically assisted reduction offers several advantages over both the closed and open reduction methods, he said.
Often in these cases, there is a volarly located distal fragment and the lunate may be stopped by the capitate.
“With the traction force of the traction tower for wrist arthroscopy, you can unlock this dislocation and, with just probing, you will achieve the reduction elegantly with everything under control. There’s no worry about the cartilage damage,” Liu said.
In addition, the grossly displaced scaphoid fracture that is associated with perilunate dislocation injuries can be anatomically reduced and percutaneous fixation can be performed under arthroscopic guidance, he said.
“Also, with arthroscopic guidance, we can have the opportunity to correct the steps and rotational deformity between the [lunotriquetral] LT interval,” Liu said.
References:
- Liu B, et al. Hand Clin. 2017;doi:10.1016/j.hcl.2017.06.002.
- Liu B, et al. J Wrist Surg. 2015;doi:10.1055/s-0035-1550162.
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Liu B. Advances in arthroscopic management of scaphoid fracture and perilunate fracture dislocation. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept.30 - Oct. 2, 2021; San Francisco (hybrid meeting).
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