Trans-scaphoid Perilunate Fracture- Dislocations - Results of Open Reduction and Internal Fixation of the Scaphoid with a Volar Approach -

Journal of the Korean Society for Surgery of the Hand 2007;12(3):125-131.
Published online September 1, 2007.

Yong Jin Kim, Sang Hyun Lee

주상골 경유 월상골 주위 골절 탈구 - 전방 접근법을 이용한 관혈적 정복술 및 내 고정술의 결과 -

김용진, 이상현

Abstract

Purpose
To review the clinical and radiological outcome of trans-scaphoid perilunate fracture dislocations treated with open reduction and internal fixation of the scaphoid with a volar approach. Materials and Methods: Thirteen patients treated over 18 years for trans-scaphoid perilunate fracture-dislocations were reviewed retrospectively at a mean of 53 months (1~17 years). The mean age of the patient was 27 years and 12 patients were men. All of the patients were dorsal dislocation and treated by open reduction with a volar approach. Fixation of the scaphoid was made by Herbert screw in 9 cases and K-wires in 4 cases. Percutaneous K-wire fixation without ligament repair of the lunotriquetral joint was done in 9 patients. The functional outcome was determined by compairing the range of motion of the injured extremity with uninjured extremity, grip strength, ability to return pre-injury employment and overall patient satisfaction. Radiologic evaluation compromised time to scaphoid union, any changes in the carpal joint. Results: Total range of motion is 84% of the uninjured wrist and grip strength is 82% of the uninjured wrist. All of the scaphoid united primarily (average time to union: 14 weeks). None of the patients developed a DISI or VISI deformity over time. Conclusion: A volar approach to the scaphoid provides adequate exposure for reduction of the carpal bones, internal fixation of the scaphoid and possible carpal tunnel release. Although perilunate fracture-dislocations are challenging problems to treat, all of the patients had acceptable pain relief and achieved sufficient range of motion and strength to return to gainful employment.