This review covers the diagnosis and surgical management of perilunate dislocations and perilunate fracture-dislocations. It addresses injury classification, radiographic recognition, operative technique, postoperative rehabilitation, and long-term outcomes. The central question: what is the current standard of care, and what do patients look like 10+ years out?
A swollen wrist after a high-energy mechanism deserves a deliberate look at the lateral radiograph: loss of radius-lunate-capitate colinearity is the diagnostic key, and missing it in 1 in 4 patients is the established failure rate.
When you identify a PLD-PLFD, perform immediate gentle closed reduction regardless of median nerve symptoms — it reduces pressure on cartilage and neurovascular structures. Stage IIB injuries (lunate rotated >90°) are the critical exception: do not attempt closed reduction, as you risk avulsing the short radiolunate ligament and its blood supply.
After successful closed reduction, plan definitive ORIF within 3-5 days once swelling subsides. For greater arc (trans-bone) injuries, fix the fracture before repairing the ligaments. The 45-day mark is the functional watershed: outcomes equivalent to acute treatment if addressed within 45 days, significantly worse beyond that.
Counsel patients that even with optimal surgery, permanent partial loss of motion and grip is the norm. The 13-year data confirm this is a guarded prognosis injury, not a return-to-baseline injury.
This review covers the diagnosis and surgical management of perilunate dislocations and perilunate fracture-dislocations. It addresses injury classification, radiographic recognition, operative technique, postoperative rehabilitation, and long-term outcomes. The central question: what is the current standard of care, and what do patients look like 10+ years out?
A swollen wrist after a high-energy mechanism deserves a deliberate look at the lateral radiograph: loss of radius-lunate-capitate colinearity is the diagnostic key, and missing it in 1 in 4 patients is the established failure rate.
When you identify a PLD-PLFD, perform immediate gentle closed reduction regardless of median nerve symptoms — it reduces pressure on cartilage and neurovascular structures. Stage IIB injuries (lunate rotated >90°) are the critical exception: do not attempt closed reduction, as you risk avulsing the short radiolunate ligament and its blood supply.
After successful closed reduction, plan definitive ORIF within 3-5 days once swelling subsides. For greater arc (trans-bone) injuries, fix the fracture before repairing the ligaments. The 45-day mark is the functional watershed: outcomes equivalent to acute treatment if addressed within 45 days, significantly worse beyond that.
Counsel patients that even with optimal surgery, permanent partial loss of motion and grip is the norm. The 13-year data confirm this is a guarded prognosis injury, not a return-to-baseline injury.