Department of Orthopaedics, ESIC Medical College, Faridabad, India.
Department of Trauma Emergency and Critical Care, All India Institute of Medical Sciences (AIIMS), Patna, India.
Injury. 2024 Jun;55 Suppl 2:111466. doi: 10.1016/j.injury.2024.111466. Epub 2024 Aug 2.
This study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature.
A total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides.
Among the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo's wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures.
Staged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures.
本研究旨在评估单阶段、双阶段和挽救性手术治疗慢性月骨周围脱位的疗效。本研究还将这些方法相互比较，并与现有文献的结果进行比较。
2013 年至 2019 年，共纳入 15 例慢性月骨周围损伤患者。采用 X 线平片进行术前和术后评估，选择性行 CT 扫描以进行详细的形态和骨折模式分析。其中 13 例行切开复位内固定术（ORIF），2 例行挽救性手术。ORIF 病例中，4 例行单阶段手术，9 例行双阶段手术。应用单侧单平面外固定架（UUEF）和双侧单平面外固定架（BUEF）分别治疗 5 例和 4 例患者。我们治疗慢性月骨周围损伤的方法多年来不断演变。我们从单阶段 ORIF 开始，然后逐步发展为双阶段手术，最初使用外固定器作为腕骨牵开器，仅应用于桡侧，最后使用双侧腕骨牵开器固定，同时应用于桡侧和尺侧。
15 例患者中，3 例失访。其中 1 例行四角融合术，其余 2 例行 UUEF。伤后至手术的平均时间间隔为 3.60 个月。术后平均舟月角测量值为 52.46°，2 例患者出现负性桡月角（提示掌屈），其余患者出现正性角（提示背伸）。2 例出现舟骨骨不连和缺血性坏死（AVN），1 例出现月骨 AVN。4 例患者出现中腕关节炎，2 例患者出现桡腕关节炎。根据 Mayo 腕关节评分进行功能评估，双阶段 BUEF 病例为良好，UUEF 和单阶段手术为满意。
与 UUEF、单阶段切开复位和挽救性手术相比，BUEF 分期复位后再行切开复位具有更好的疗效。
4 级。
