Treatment of acute perilunate dislocations: ORIF versus proximal row carpectomy

Purpose Some authors have proposed performing proximal row carpectomy (PRC) as the initial treatment for perilunate dislocations. Hypothesis The goal of this retrospective study was to compare the results of a cohort of perilunate dislocation cases that were operated by open reduction and internal fixation (ORIF) or by PRC between 2006 and 2011. Methods The cohort consisted of 21 men with a mean age of 33 years, who either had an isolated perilunate dislocation (7 cases) or a fracture–dislocation (14 cases). All dislocations were dorsal, with 10 stage I and 12 stage II. Thirteen patients had been treated by ORIF (group 1) a mean of 1.2 days after the injury. Eight patients had been treated by PRC (group 2) a mean of 18.7 days after the injury. Immobilization time was 6–12 weeks in group 1 and 2 weeks in group 2. Results The mean operative time was 95 minutes in group 1 and 65 minutes in group 2. After a mean follow-up of 35 months, the following outcomes were found for groups 1 and 2, respectively: pain 3/10 and 1/10, strength 77% and 73%, strength in supination 79% and 93%, strength in pronation 67% and 95%, QuickDASH 27/100 and 16/100, PRWE 43/150 and 15.5/150, flexion 69% and 57%, extension 84% and 58%, pronation 97% and 103%, supination 98% and 97%. There were four cases of osteoarthritis in both groups. Conclusion Treatment of acute perilunate dislocations by PRC leads to medium-term results that are at least as good as those with ORIF treatment. The surgery duration is shorter with PRC, as is the immobilization period. Type of study Retrospective comparative. Level of evidence III.