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Assessment of Clinical and Patient-Reported Recovery after Perilunate Injuries: A Systematic Review of Open Treatment Approaches
Julia A. Cook, MD; Scott N. Loewenstein, MD; Steven Dawson, MD; Joshua M. Adkinson, MD; Brian M. Christie, MD, MPH
Indiana University School of Medicine
2023-02-04
Presenter: Julia A. Cook
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The work is the sole work of the authors.
Director Name: William Wooden, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Open reduction and fixation of perilunate injuries (PLIs) has been described using a dorsal, volar, or combined dorsal and volar approach. This systematic review assesses the effect of approach on clinical and patient-reported outcomes (PRO) in the open treatment of PLIs.
Materials & Methods: A systematic review was performed from January 2001 to January 2023 to identify original studies describing clinical and patient-reported outcome measures following open treatment of PLIs. Collected variables included patient demographics, surgical characteristics, time of immobilization, scapholunate (SL) interval, flexion-extension arc, and PRO scores.
Results: Sixteen studies met inclusion criteria; all studies were case series. A total of 249 patients (94.8% male) were included in the analysis: 165 had a dorsal approach, 28 had a volar approach, and 56 had a combined approach. Average age was 33.8±3.7 years. Average follow up was 20.4±20.7 months (6-288 months).
Flexion-extension arc significantly differed between all groups, with an average arc of 85.2° in the combined group, 96.8° in the dorsal group, and 110.6° in the volar group (p<0.001).
Disabilities of the Arm, Shoulder, and Hand scores were significantly higher in the combined group (37.9 points) compared to both the dorsal and volar approaches (p<0.001). Modified Mayo Wrist scores were lowest in the combined group (67.9 points), which significantly differed from the dorsal and volar groups (p<0.001).
Conclusions:
An isolated volar or dorsal approach to PLIs results in improved wrist range of motion and PROs compared to a combined volar/dorsal approach.
