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Introduction <p>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.</p> Materials and methods <p>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 <i>p</i> ≤ 0.05. The calculations were performed with R (version 4.3.2).</p> Results <p>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 (<i>p</i> = 0.0031) compared to PLFD. Older patients presented also with higher stages of perilunate instability (<i>p</i> = 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, <i>p</i> = 0.04), while a higher number of wrist transfixations increased the risk of advanced arthrosis (OR = 2.427, <i>p</i> = 0.02), The logistic regression model detected a positive effect of the number of wrist transfixations on lunate fovea arthrosis (<i>p</i> = 0.048). The number of wrist transfixations did not correlate with the number of fractures (<i>p</i> = 0.06), Mayfield classification (<i>p</i> = 0.16), or intraoperative reduction outcome (<i>p</i> = 0.6).</p> Conclusion <p>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.</p>

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Do perilunate dislocations and fracture-dislocations result in different radiological outcomes following wrist alignment reconstruction? A single-center retrospective study including 51 patients with perilunate injuries

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  • 发表日期：

    2025年1月3日

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  • Katarzyna Rachunek-Medved,
  • Fabian Medved,
  • Wojciech Besz,
  • Claudius Illg,
  • Henrik Lauer,
  • Sabrina Krauß,
  • Adrien Daigeler,
  • Johannes Tobias Thiel

摘要

Introduction

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.

Materials and methods

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).

Results

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).

Conclusion

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.