Proximal row carpectomy for complex perilunate fracture dislocations with migration of proximal scaphoid bone into the forearm

• Published in: Hand surgery and rehabilitation 2021-06, Vol.40 (3), p.299-304
• Main Authors: Jerome, T.J., Prabu, G.R.
• Format: Article
• Language: English
• Subjects: Complex perilunate fracture dislocation; Extended migration; Luxation-fracture périlunaire complexe; Migration étendue; Proximal row carpectomy; Proximal scaphoid pole; Pôle proximal du scaphoïde; Résection de la rangée proximale du carpe
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2020.12.002

Complex perilunate dislocations include scaphoid, triquetrum, radial styloid fractures, and associated ligamentous injuries. The purpose of the study is to assess the role of proximal row carpectomy (PRC) in such complex injuries involving the proximal scaphoid migration and analyze the outcome. We operated on eighteen patients with complex perilunate dislocations and extreme proximal migration of proximal scaphoid by PRC between 2012 and 2018. We analyzed the postoperative radiographs, VAS pain score, range of motion, return to work, Quick DASH and Mayo wrist scores and assessed the overall functional outcome. The average follow-up was 46 months. The mean range of wrist flexion was 65%, extension 70 %, pronation 88%, supination 90%, and grip strength 70% of the opposite side. The median VAS pain score was 0.1 (range, 0–3). Median Quick DASH score was 4.4 (range, 3.3–6.7), and Mayo wrist score 70 (range, 65–75). The age, gender, side of injury, dominant hand, fracture displacement or type, osteochondral fracture of the capitate head, and treatment delay had no significant impact on the functional outcome. The presence of degenerative changes had no significant association with age, grip strength, range of movements, pain, and outcome scores. All patients had good subjective satisfaction with the surgery and functional outcome. PRC is a reliable option for complex perilunate fracture-dislocations with extended proximal migration of the scaphoid proximal pole. The degenerative changes after PRC may progress with time, mostly when done for young patients. Outcomes of salvage procedure in the long-term follow-up need to be taken into account when counselling patients on the treatment of these injuries. Les luxations périlunaires complexes incluent des fractures du scaphoïde, du triquetrum, du processus styloïde du radius et des lésions ligamentaires associées. Le but de cette étude était d’évaluer l’intérêt de la résection de la rangée proximale du carpe (RRPC) dans de tels traumatismes complexes comprenant une migration proximale du scaphoïde et d’en analyser le résultat. Nous avons traité 18 patients pour une luxation périlunaire complexe avec migration proximale importante du fragment proximal du scaphoïde par RRPC entre 2012 et 2018. Nous avons analysé les radiographies postopératoires, la douleur évaluée sur une échelle visuelle analogique (EVA), la mobilité du poignet, la reprise du travail, le score QuickDASH et le score de la Mayo Clinic pour le poigne