Arthroscopically assisted temporary trans-articular headless screw fixation for perilunate injuries: A retrospective study.

BACKGROUND

Perilunate injuries are rare high-energy wrist injuries whose open treatment carries a risk of capsular stiffness and carpal devascularisation. Arthroscopically assisted reduction with temporary fixation aims to limit this morbidity, and temporary trans-articular headless compression screws may provide more rigid scapholunate and lunotriquetral control than Kirschner wires. We asked what the mid-term clinical, radiographic and patient-reported outcomes of this technique are, using the contralateral wrist as a paired control, and whether they differ by injury pattern.

METHODS

Retrospective single-centre study of 11 consecutive patients (10 men; mean age 37 years) with a closed perilunate dislocation (n = 7), trans-scaphoid perilunate fracture-dislocation (n = 3) or perilunate injury not dislocated (n = 1) treated between November 2015 and December 2020. All 11 were analysed by intention to treat; injured-versus-contralateral comparisons (Wilcoxon signed-rank test) were restricted to the 10 wrists that retained the index construct. Median follow-up was 47 months.

RESULTS

One patient (9%) required four-corner fusion for scapholunate advanced collapse, and radiographic osteoarthritis was seen in 2/11 (18%). The flexion-extension arc (113° vs 132°, p = 0.002) and the scapholunate angle (60° vs 50°, p = 0.018) were significantly worse than the uninjured wrist; grip strength and radiolunate angle did not differ significantly. Median QuickDASH was 4.5 and median PRWE 7.

CONCLUSION

In selected closed, reducible perilunate injuries this technique gave good patient-reported outcomes and maintained carpal alignment in most patients, but flexion-extension and the scapholunate angle remained reduced relative to the uninjured wrist and one in eleven required salvage fusion. Comparative studies are needed before recommending it over open fixation.

LEVEL OF EVIDENCE: IV (retrospective case series).