Acutely Performed Proximal Row Carpectomy for Perilunate and Lunate Dislocations: Case Series and Review of Literature

Abstract

Background:

Acutely performed proximal row carpectomy (PRC) is a viable alternative to open reduction internal fixation for perilunate and/or lunate dislocations, offering comparable outcomes with fewer postoperative complications. Studies report good motion, low complication, and reoperation rates. However, limited research exists on acute PRC for perilunate dislocations (PLDs), warranting further investigation into its functional outcomes.

Methods:

A retrospective chart review was conducted on adult patients who underwent acute PRC for PLDs and perilunate fracture-dislocations (PLFDs) at a single institution (2010-2022). Inclusion criteria encompassed patients aged above 18 years with perilunate or lunate dislocation/fracture-dislocation treated with PRC within 21 days post-injury, among other criteria. Fourteen patients met our inclusion criteria. Patient-reported outcomes (PROs) were collected through phone surveys and final clinic visits, using Patient-Rated Wrist Evaluations (PRWEs), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), visual analog scale (VAS) pain scores, and return-to-work statuses. Surgical approaches, patient demographics, and injury characteristics were analyzed.

Results:

In our cohort (average age 49.4 years), injuries were due to motor vehicle collisions (57%) and falls (43%). Proximal row carpectomy was performed within an average of 5.6 days post-injury, and patients were contacted an average of 68.0 months post-surgery. Return-to-work rates were favorable, with 35.7% returning without restrictions and 35.7% with restrictions. Patient-reported outcomes, encompassing VAS (1.31), QuickDASH (20.5), and PRWEs (24.5), demonstrated favorable results.

Conclusions:

This study provides novel insights into the outcomes of acute PRC for perilunate and lunate dislocations, expanding on limited existing literature. It highlights PRC as a viable intervention for PLDs and PLFDs, demonstrated by substantial return-to-work rates and positive PROs.