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Perilunate fracture dislocation fixation

If you need a perilunate fracture dislocation fixation, please Schedule an appointment with one of our orthopedic specialists as soon as possible.

Perilunate Fracture Dislocation Fixation

A perilunate fracture dislocation is a complex wrist injury involving fractures and dislocations around the lunate bone. The lunate, a crescent-shaped bone in the center of the wrist, plays a critical role in maintaining wrist stability and enabling movement. Perilunate fractures occur when the lunate dislocates, accompanied by fractures in the surrounding carpal bones. Due to the injury’s severity, managing and fixing perilunate fracture dislocations presents significant challenges. Timely intervention and precise surgical techniques are crucial to prevent long-term disability.

Causes and Mechanism of Injury

High-energy trauma, such as falls from a height, motor vehicle accidents, or sports injuries, often causes perilunate fracture dislocations. Typically, the injury mechanism involves hyperextension and rotation of the wrist, causing the lunate to dislocate from its normal position within the carpal bones. As a result, the dislocation can lead to fractures in the distal radius, scaphoid, or other carpal bones, complicating the treatment further. Surgeons classify the injury pattern into different types based on the specific fractures and dislocations involved.

Clinical Presentation

Patients with a perilunate fracture dislocation usually present with significant pain, swelling, and visible deformity of the wrist. In some cases, the lunate may visibly displace from its usual position. During clinical examination, physicians may find a reduced range of motion, tenderness around the wrist, and possible neurovascular deficits caused by compression of the median nerve or other structures.

Diagnosis

To confirm the diagnosis of a perilunate fracture dislocation, physicians combine physical examination with imaging studies. X-rays serve as the first line of imaging, clearly showing the characteristic dislocation and fractures. Surgeons may use additional imaging, such as CT scans or MRI, to assess the extent of bone involvement, soft tissue damage, and injuries to the surrounding ligaments and tendons. These studies are essential for planning the surgical approach and fixation method.

Surgical Treatment

Surgical reduction and fixation serve as the primary treatment for perilunate fracture dislocations. Surgeons aim to restore the carpal bones’ normal alignment, stabilize the wrist, and minimize the risk of complications, such as arthritis or chronic instability.

  • Approach: The surgical approach varies depending on the injury pattern and the bones involved. Typically, open reduction is necessary, repositioning the dislocated bones into their proper anatomical alignment. Surgeons may need to fixate fractures in the scaphoid, lunate, or radius using screws, plates, or pins.

  • Fixation Techniques: Surgeons use several fixation techniques, including:

    • Internal Fixation (IF): Metal screws, plates, or pins stabilize the fractures. The choice of implant depends on the specific bone and fracture pattern. For example, screws often stabilize scaphoid and radius fractures, while pins might be required to stabilize the lunate.
    • External Fixation: Surgeons may employ external fixators when severe instability exists or when internal fixation isn’t feasible. This method helps maintain alignment during the healing process.
    • Ligament Reconstruction: In some cases, ligaments surrounding the lunate and carpal bones may also sustain injury, requiring repair or reconstruction.

  • Timing of Surgery: Timing plays a critical role in optimizing surgical outcomes. Surgeons must perform early reduction and fixation to prevent long-term complications, such as avascular necrosis of the lunate or chronic wrist instability. Delayed or inadequate fixation may lead to post-traumatic arthritis, reduced range of motion, and persistent pain.

Rehabilitation and Recovery

After surgery, physicians usually immobilize the wrist for several weeks to allow the bones to heal and soft tissues to recover. A structured rehabilitation program is essential for restoring wrist function, strength, and range of motion. This program often includes physical therapy focusing on wrist mobilization, strengthening exercises, and a gradual return to activity. The rehabilitation process varies depending on the injury’s complexity and the surgical approach, typically lasting several months.

 

If you would like to speak to an Orthopedic Specialist, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.