Jupiter Jesse B, Nunez Fiesky A, Nunez Fiesky, Fernandez Diego L, Shin Alexander Y
Hansj�rg Wyss/AO Professor, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Instr Course Lect. 2018 Feb 15;67:155-174.
Although perilunate injuries represent only 5% of all carpal injuries, they compose a spectrum of devastating complex wrist injuries. Perilunate injuries result from high-energy trauma to the wrist and may be associated with multiple fractures, dislocations, and ligament injuries. Although the diagnosis of a perilunate injury is made via radiographic assessment, missed diagnosis occurs in 25% of patients with a perilunate injury. Immediate diagnosis of perilunate injuries is critical to optimize patient outcomes. Closed reduction of perilunate injuries is performed to avoid permanent damage to the median nerve and other compromised structures. As swelling subsides, open reduction is performed to restore anatomic alignment, attain stable fixation, and repair the ligaments. Despite optimal management of perilunate injuries, complications, including median nerve dysfunction, complex regional pain syndrome, carpal instability, and late posttraumatic arthritis, may occur. Satisfactory outcomes can be achieved in patients with a perilunate injury via prompt recognition and timely surgical management. Although radiographic signs of arthritis develop in many patients with a perilunate injury, these radiographic signs do not necessarily correlate with functional outcomes. Some patients with a perilunate injury require salvage procedures for the management of persistent complications. Radiocarpal fracture-dislocations are a complex wrist fracture-dislocation pattern. Radiocarpal fracture-dislocations generally result from high-energy trauma and are characterized by a carpal dislocation, which usually involves a small portion of the rim of the dorsal or volar aspect of the distal radius. Neurologic dysfunction and elevated intracompartment pressure may be present in patients with a radiocarpal fracture-dislocation. Wrist fracture-dislocations are associated with a number of complications, including intercarpal instability, later arthrosis, carpal nonunion, and loss of radiocarpal mobility.
尽管月骨周围损伤仅占所有腕部损伤的5%，但它们构成了一系列严重的复杂腕部损伤。月骨周围损伤是由腕部的高能创伤引起的，可能与多处骨折、脱位和韧带损伤有关。虽然月骨周围损伤的诊断是通过影像学评估做出的，但在25%的月骨周围损伤患者中会出现漏诊。月骨周围损伤的及时诊断对于优化患者预后至关重要。进行月骨周围损伤的闭合复位以避免正中神经和其他受损结构受到永久性损伤。随着肿胀消退，进行切开复位以恢复解剖对线、实现稳定固定并修复韧带。尽管对月骨周围损伤进行了最佳管理，但仍可能发生并发症，包括正中神经功能障碍、复杂性区域疼痛综合征、腕关节不稳定和创伤后晚期关节炎。通过及时识别和及时的手术管理，月骨周围损伤患者可以取得满意的结果。虽然许多月骨周围损伤患者会出现关节炎的影像学征象，但这些影像学征象不一定与功能结果相关。一些月骨周围损伤患者需要进行挽救手术来处理持续的并发症。桡腕关节骨折脱位是一种复杂的腕关节骨折脱位类型。桡腕关节骨折脱位通常由高能创伤引起，其特征是腕骨脱位，通常涉及桡骨远端背侧或掌侧边缘的一小部分。桡腕关节骨折脱位患者可能存在神经功能障碍和骨筋膜室内压力升高。腕关节骨折脱位与许多并发症相关，包括腕骨间不稳定、后期关节病、腕骨不愈合和桡腕关节活动度丧失。
