Treatment of acute lunate and perilunate dislocations.

In 55 wrists with dorsal perilunate dislocations, trans-scaphoid dorsal perilunate fracture dislocations and volar lunate dislocations, an anatomic reduction was achieved by closed manipulation in 67% of the cases. After anatomic reduction, 59% of the wrists lost anatomic position during the first six weeks of treatment despite adequate external immobilization. Closed treatment alone was successful in achieving and maintaining an anatomic reduction only 27% of the time. Open treatment was successful in gaining anatomic reduction 75% of the time and was uniformly successful in maintaining the reduction. In view of these results, the authors recommend open reduction and Kirschner wire fixation of displaced lunate and perilunate dislocations.