Multicenter retrospective study of 166 perilunate dislocations and fracture-dislocations across 7 centers. Presents a radiographic classification system and evaluates clinical and radiologic outcomes in 115 cases with minimum 1-year follow-up (mean 6 years 3 months). The study asks which injury characteristics and treatment factors determine outcome.
A quarter of perilunate injuries are missed at initial presentation — and fracture-dislocations are not safer than pure dislocations in this regard. When a patient comes in after high-energy wrist trauma, get a true lateral and look for the normal collinear alignment of radius, lunate, and capitate. If that line is broken, the diagnosis is in front of you.
The 45-day window is the most actionable number in this paper. Treat within a week and clinical scores average 80 (good). Treat after 45 days and they drop to 57 (poor), a statistically significant and clinically striking difference. The biology behind this is ligamentous healing phases. After 45 days, the window for meaningful soft tissue repair has closed.
For transscaphoid injuries specifically, fixation of the scaphoid is necessary but not sufficient. Before closing, assess the scapholunate ligament directly. Missed concurrent scapholunate disruption leads to progressive instability, ulnar translation, and carpal collapse even after a healed scaphoid.
This paper is also why we counsel patients honestly: even optimal early treatment carries a 56% arthritis rate at 6 years. Good clinical function and poor radiographs can coexist early, but the gap narrows with time.
Multicenter retrospective study of 166 perilunate dislocations and fracture-dislocations across 7 centers. Presents a radiographic classification system and evaluates clinical and radiologic outcomes in 115 cases with minimum 1-year follow-up (mean 6 years 3 months). The study asks which injury characteristics and treatment factors determine outcome.
A quarter of perilunate injuries are missed at initial presentation — and fracture-dislocations are not safer than pure dislocations in this regard. When a patient comes in after high-energy wrist trauma, get a true lateral and look for the normal collinear alignment of radius, lunate, and capitate. If that line is broken, the diagnosis is in front of you.
The 45-day window is the most actionable number in this paper. Treat within a week and clinical scores average 80 (good). Treat after 45 days and they drop to 57 (poor), a statistically significant and clinically striking difference. The biology behind this is ligamentous healing phases. After 45 days, the window for meaningful soft tissue repair has closed.
For transscaphoid injuries specifically, fixation of the scaphoid is necessary but not sufficient. Before closing, assess the scapholunate ligament directly. Missed concurrent scapholunate disruption leads to progressive instability, ulnar translation, and carpal collapse even after a healed scaphoid.
This paper is also why we counsel patients honestly: even optimal early treatment carries a 56% arthritis rate at 6 years. Good clinical function and poor radiographs can coexist early, but the gap narrows with time.