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J Wrist Surg 2022; 11(02): 164-176
DOI: 10.1055/s-0041-1735841
Scientific Article

Perilunate Injury Timing and Treatment Options: A Systematic Review

Mark J.W. van der Oest 
1   Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Liron S. Duraku
1   Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Madina Artan
1   Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Caroline A. Hundepool
1   Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Dominic M. Power
2   Department of Birmingham Hand Centre, Queen Elisabeth Hospital, University of Birmingham, Birmingham, United Kingdom
,
Vaikunthan Rajaratnam
3   Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
,
J. Michiel Zuidam
1   Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
› Author Affiliations Funding None.
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Abstract

Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment.

Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7–45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD.

Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD.

Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.

Keywords

Perilunate injuries - surgical treatment - time frame - ORIF

Ethical Approval

Ethical approval is not needed for systematic reviews.




Publication History

Received: 24 March 2021

Accepted: 19 July 2021

Article published online:
05 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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