Scaphoid Excision and Four-Corner Fusion for Neglected Perilunate Dislocations: Preliminary Results

Abstract

Background: Perilunate dislocations are severe uncommon carpal injuries. They are sometimes missed with a reported incidence of up to 25%. Neglect for a period of time allows for soft tissue contractures, as well as bony changes that make reduction extremely difficult. For neglected cases, procedures such as staged open reduction, proximal row carpectomy, and wrist arthrodesis have been offered. The objective of this study was to examine whether scaphoid excision and four-corner fusion could be used to treat neglected perilunate dislocations. Methods: Ten patients with neglected perilunate dislocations were managed by scaphoid excision and four-corner fusion. The dominant hand was involved in eight cases. Graft material for the fusion was obtained from the excised scaphoid. Results: Six patients had complete relief of pain both at rest and during stressful activities. Two patients had no pain at rest and mild pain on stressful activities. The remaining two patients had mild pain at rest and moderate pain on stressful activities. The arc of extension/flexion of the wrist and grip strength both improved as compared to their preoperative levels. The average postoperative Quick DASH score was 12.5. Conclusions: Scaphoid excision with four corner fusion could be used to treat neglected perilunate dislocations with good pain relief and good hand function.