Rachunek-Medved Katarzyna, Medved Fabian, Besz Wojciech, Illg Claudius, Lauer Henrik, Krauß Sabrina, Daigeler Adrien, Thiel Johannes Tobias
Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tübingen, Germany.
Arch Orthop Trauma Surg. 2025 Jan 3;145(1):106. doi: 10.1007/s00402-024-05744-1.
Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are high-energy wrist injuries often linked to significant post-traumatic osteoarthritis. This study aims to determine whether PLD and PLFD yield different radiological outcomes following surgical treatment while identifying prognostic factors for worse outcomes.
We retrospectively analyzed 51 patients treated for perilunate injuries between 2000 and 2022. Radiographic evaluation included postoperative carpal alignment, scapholunate distance, ulnar translocation, and postoperative arthrosis according to the Kellgren-Lawrence scale. Logistic regression models were used in the study. The analyzed explanatory variables included: type of injury (PLFD/PLD), Mayfield classification, capsulodesis, repair of intercarpal- and extrinsic ligaments, and number of wrist transfixations. The significance level was set at p ≤ 0.05. The calculations were performed with R (version 4.3.2).
Among 51 patients, the mean follow-up was 4.33 years (1-22.13), and the mean age was 37.76 years. PLFD accounted for 55% of cases. Patients in the PLD group were older at the time of injury (p = 0.0031) compared to PLFD. Older patients presented also with higher stages of perilunate instability (p = 0.0061). Midcarpal arthrosis was the most common site of wrist degeneration (58.8%). Ordinal logistic regression indicated that PLFD was associated with a lower risk of midcarpal arthrosis (OR = 0.293, p = 0.04), while a higher number of wrist transfixations increased the risk of advanced arthrosis (OR = 2.427, p = 0.02), The logistic regression model detected a positive effect of the number of wrist transfixations on lunate fovea arthrosis (p = 0.048). The number of wrist transfixations did not correlate with the number of fractures (p = 0.06), Mayfield classification (p = 0.16), or intraoperative reduction outcome (p = 0.6).
PLD and a greater number of wrist transfixations were associated with a higher risk of wrist arthrosis. Limiting wrist pinning to essential procedures may help prevent additional iatrogenic chondral lesions.
月骨周围脱位（PLD）和月骨周围骨折脱位（PLFD）是高能量腕部损伤，常与严重的创伤后骨关节炎相关。本研究旨在确定PLD和PLFD在手术治疗后是否会产生不同的放射学结果，同时确定预后较差的危险因素。
我们回顾性分析了2000年至2022年间接受月骨周围损伤治疗的51例患者。影像学评估包括术后腕骨排列、舟月间距、尺骨移位以及根据凯尔格伦-劳伦斯量表评估的术后关节病。本研究使用了逻辑回归模型。分析的解释变量包括：损伤类型（PLFD/PLD）、梅菲尔德分类、关节囊固定术、腕骨间和外在韧带修复以及腕部固定针数量。显著性水平设定为p≤0.05。计算使用R（版本4.3.2）进行。
51例患者中，平均随访时间为4.33年（1 - 22.13年），平均年龄为37.76岁。PLFD占病例的55%。与PLFD相比，PLD组患者受伤时年龄更大（p = 0.0031）。老年患者月骨周围不稳定程度也更高（p = 0.0061）。腕中关节病是腕部退变最常见的部位（58.8%）。有序逻辑回归表明，PLFD与腕中关节病风险较低相关（OR = 0.293，p = 0.04），而腕部固定针数量增加会增加晚期关节病风险（OR = 2.427，p = 0.02），逻辑回归模型检测到腕部固定针数量对月骨凹关节病有正向影响（p = 0.048）。腕部固定针数量与骨折数量（p = 0.06）、梅菲尔德分类（ p = 0.16）或术中复位结果（p = 0.6）均无相关性。
PLD和更多的腕部固定针与腕关节病风险较高相关。将腕部穿针限制在必要的操作可能有助于预防额外的医源性软骨损伤。
