The treatment of perilunate ligament injuries in multiply injured patients

Purpose Perilunate injuries are rare, severe injuries of the carpus. They can present as isolated injuries or in the poly-traumatised patient. This is the first documented series of these injuries treated in a Major Trauma Centre. The aims were to assess the management, treatment algorithm and outco...

Full description

Saved in:

Bibliographic Details
Published in:	European journal of trauma and emergency surgery (Munich : 2007) Vol. 45; no. 1; pp. 73 - 81
Main Authors:	Brown, K. V., Tsekes, D., Gorgoni, C. G., Di Mascio, L.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2019 Springer Nature B.V
Subjects:	Adolescent Adult Critical Care Medicine Emergency medical care Emergency Medicine Female Humans Injuries Injury Severity Score Intensive Joint and ligament injuries Ligaments, Articular - injuries Ligaments, Articular - surgery London Lunate Bone - injuries Lunate Bone - surgery Male Medicine Medicine & Public Health Middle Aged Multiple Trauma Original Article Orthopedic Procedures - methods Orthopedics Patients Rehabilitation Retrospective Studies Sports Medicine Surgery Surgical Orthopedics Surgical outcomes Trauma Centers Traumatic Surgery Treatment Outcome Wrist Injuries - surgery London United Kingdom > UK Treatment Polytrauma Injury Perilunate
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Purpose Perilunate injuries are rare, severe injuries of the carpus. They can present as isolated injuries or in the poly-traumatised patient. This is the first documented series of these injuries treated in a Major Trauma Centre. The aims were to assess the management, treatment algorithm and outcomes, of perilunate injuries in our department, review whether concomitant polytrauma affected those outcomes and identify if delay to definitive treatment had a significant effect on overall outcome. Methods Perilunate injuries admitted to the Royal London Hospital between Oct 2011 and March 2016 were identified. All definitive surgical procedures were performed by the senior author; hand therapists supervised patient rehabilitation. Outcomes were assessed by Mayo Wrist and QuickDASH scores. Results We identified 23 perilunate injuries (22 patients). There was an associated nerve injury in 10 cases with other system injuries present in 12 cases. At final review, the mean carpal height ratio was 0.56, Mayo Wrist score was 81 and QuickDASH score was 16.4. There were no differences when comparing the outcomes of patients who had early against those with more delayed definite treatment or when comparing patients with isolated wrist injuries against polytrauma patients. Conclusion Satisfactory outcomes can be achieved, even in the presence of other injuries, if initial treatment is prompt and follows a clear management protocol. Prompt early reduction and neurological decompression followed by subsequent accurate definitive fixation leads to good outcomes. A delay of definitive fixation of up to 18 days does not appear to have a deleterious effect on outcome.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1863-9933 1863-9941
DOI:	10.1007/s00068-017-0856-9