Jagiella-Lodise Olivia, Sweeney Aidan, Ghareeb Paul, Zelenski Nicole A
University of Pennsylvania, Philadelphia, USA.
Emory University, Atlanta, GA, USA.
Hand (N Y). 2025 Feb 13:15589447251317236. doi: 10.1177/15589447251317236.
Perilunate dislocations are severe upper extremity dislocations to the wrist involving ligamentous injury. Previous literature cites closed reduction of perilunate injuries at 25%. Herein, the technique and results of closed reductions for perilunate dislocations are described.
Chart reviews were conducted of perilunate injuries treated from 2017 to 2022. Imaging was evaluated to categorize by Herzberg stage. Reduction was performed in the emergency department (ED) and involved traction, relaxation, and manipulation. Reduction attempts and success rates were recorded as were presence and resolution of median nerve symptoms.
Fifty-six perilunate injuries were included with an average age of 36 years. Forty-five (80%) underwent attempted closed reduction, of which 37 (82%) were successful. Twenty-seven (48%) were Herzberg I, 18 (32%) were Herzberg IIA, and 11 (20%) were Herzberg IIB. Two Herzberg IIB injuries were mal-reduced, with the lunate returned to the lunate fossa inverted. Scaphoid fractures were more likely in Herzberg I injuries and did not influence the success of reduction. Thirty (54%) patients presented with median nerve symptoms, of which 25 underwent attempted closed reduction in ED. Perilunate reduction resolved nerve symptoms in 92% of cases. Nerve symptoms were not more common in Herzberg II perilunate injuries. Successful closed reduction of perilunate injuries was not associated with a specific Herzberg stage.
Closed perilunate reductions in the ED can have a high success rate >80%. Herzberg II perilunate injuries have >70% (76%) success rate in closed reduction. Rates of median nerve symptoms were high and resolved in most cases (92%) after reduction. Closed reduction of perilunate injuries can safely be attempted in the ED and resolves nerve compression prior to surgery.
月骨周围脱位是累及韧带损伤的严重腕部上肢脱位。既往文献显示月骨周围损伤的闭合复位率为25%。本文描述了月骨周围脱位闭合复位的技术及结果。
对2017年至2022年治疗的月骨周围损伤病例进行图表回顾。通过影像学检查根据赫兹伯格分期进行分类。在急诊科进行复位，包括牵引、放松和手法操作。记录复位尝试及成功率，以及正中神经症状的出现及缓解情况。
纳入56例月骨周围损伤病例，平均年龄36岁。45例（80%）尝试进行闭合复位，其中37例（82%）成功。27例（48%）为赫兹伯格I期，18例（32%）为赫兹伯格IIA期，11例（20%）为赫兹伯格IIB期。2例赫兹伯格IIB期损伤复位不良，月骨呈反向回到月骨窝。赫兹伯格I期损伤中舟骨骨折更常见，但不影响复位成功率。30例（54%）患者出现正中神经症状，其中25例在急诊科尝试进行闭合复位。月骨周围复位使92%的病例神经症状得到缓解。赫兹伯格II期月骨周围损伤中神经症状并不更常见。月骨周围损伤的成功闭合复位与特定的赫兹伯格分期无关。
急诊科月骨周围损伤的闭合复位成功率较高，>80%。赫兹伯格II期月骨周围损伤的闭合复位成功率>70%（76%）。正中神经症状发生率较高，复位后大多数病例（92%）症状得到缓解。在急诊科可安全尝试月骨周围损伤的闭合复位，并在手术前缓解神经压迫。
