Trans-Scaphoid Perilunate Fracture-Dislocation and Isolated Perilunate Dislocations; Surgical Versus Non Surgical Treatment

Background: Trans-scaphoid perilunate fracture-dislocation and perilunate dislocations are among uncommon injuries, most commonly seen in young patients due to high energy trauma. The treatment can be achieved either surgically by open reduc tion and internal fixation or closed reduction and casting.   Methods: To compare surgical versus non-operative results of treatment of trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocation, we collected the data of 34 patients who were treated at least 5 years before our study, twenty of whom were treated surgically and fourteen were treated nonsurgical. We compared clinical and radiological findings in two groups. Functional outcome was assessed by Mayo wrist score for each patient. Results: The surgically treated patients had much higher Mayo wrist scores, 85 and 87.78 for perilunate dislocation and trans-scaphoid fracture-dislocation respectively, while 71 and 71.11 in non-surgically treated group respectively. Wrist range of motion was also more favorable in operative group (55 flexion - 54.28 extension for trans-scaphoid fracture-dislocations and 50 flexion, 51.66 extension for perilunate dislocations)than non-operative group(48.5 flexion, 48.1 extension for trans-scaphoid fracture-dislocations and 48.1 flexion, 50 extension for perilunate dislocation). The radiographic changes showed arthritic changes but those changes did not significantly interfered with functional outcome and wrist scores. Conclusion: Regarding our better clinical results after early open reduction and internal fixation for these injuries, we can suggest the operativetreatment of these complicated hand injuries.