Kirschner WIRE FIXATION IN THREE JOINTS COMBINED WITH BONE ANCHOR REPAIR FOR TREATMENT OF ACUTE PERILUNATE INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOUYan ,  LIUShiqing , YULing , LIAOQi , HUANGTao , ZHAOQi , ZHANGChun

No. Ⅲ Department of Orthopaedics, Renmin Hospital of Wuhan University, Wuhan Hubei, 430060, P. R. China;

Corresponding author：

LIUShiqing, Email: professorgu@hotmail.com

Keywords：

Wrist joint; Perilunate injury; Bone anchor; Kirschner wire

DOI：

10.7507/1002-1892.20140237

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Objective To investigate the effectiveness of Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint combined with bone anchor repair for the treatment of acute perilunate injury. Methods Between January 2007 and January 2012, 35 cases of acute perilunate injury were treated. There were 30 males and 5 females with an average age of 45.5 years (range, 32-56 years). Fractures were caused by falling from height in 18 cases, by traffic accident in 11 cases, and by fall injury in 4 cases. The time from injury to operation was 2-6 days (mean, 3.4 days). There were 23 cases of trans-scaphoid perilunate dislocation, 10 cases of perilunate dislocation, and 2 cases of trans-triangular perilunate dislocation. Associated injuries included median nerve injury in 6 cases, radius styloid fracture in 8 cases, ulnar styloid fracture in 2 cases, and distal tibial fracture in 1 case. All the patients were treated by open reduction, Herbert screw fixation of scaphoid fractures, and Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint, and the intercarpal ligaments were repaired by Mitek bone anchor. Results Superficial wound infection occurred in 2 cases, and primary healing of incision obtained in others. Thirty-five patients were followed up 12-35 months (mean, 18 months). X-ray films showed fracture union in 21 cases of scaphoid fractures, and bone nonunion in 2 cases of scaphoid fractures. During the follow-up period, there was no avascular necrosis of scaphoid or lunate. At last follow-up, the scapholunate angle, radiolunate angle, and wrist range of motion (ROM) in extension had no significant difference between affected and unaffected sides (P > 0.05). The wrist ROM in flexion and grip strength of affected side were not up to the levels of unaffected side (P < 0.05). According to the modified Mayo wrist scoring system, the score was 79.9±10.7, which were excellent in 8 cases, good in 17 cases, fair in 7 cases, and poor in 3 cases, and the excellent and good rate was 71.4%. The disability of arm-shoulder-hand (DASH) questionnaires score was 21±10. Traumatic osteoarthritis was observed in 2 cases. Conclusion Kirschner wire fixation in scapholunate joint, capitolunate joint, and lunotriquetral joint combined with bone anchor repair for the treatment of acute perilunate injury can get early stability of the carpal joint, favorable intercarpal ligament repair, and good recovery of wrist joint function.

Citation： ZHOUYan, LIUShiqing, YULing, LIAOQi, HUANGTao, ZHAOQi, ZHANGChun. Kirschner WIRE FIXATION IN THREE JOINTS COMBINED WITH BONE ANCHOR REPAIR FOR TREATMENT OF ACUTE PERILUNATE INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1086-1091. doi: 10.7507/1002-1892.20140237 Copy

1.	Sawardeker PJ, Kindt KE, Baratz ME.Fracture-dislocations of the carpus:perilunate injury.Orthop Clin North Am, 2013, 44(1):93-106.
2.	Garg B, Goyal T, Kotwal PP.Staged reduction of neglected transscaphoid perilunate fracture dislocation:a report of 16 cases.J Orthop Surg Res, 2012, (7):19.
3.	陈振兵, 洪光祥, 王发斌.上肢功能评定表.中国修复重建外科杂志, 2004, 18(6):520-521.
4.	徐达传, 黄美贤.手舟骨的形态血供特点及其临床意义.中华关节外科杂志(电子版), 2010, 4(2):251-255.
5.	Komurcu M, Kürklü M, Ozturan KE, et al.Early and delayed treatment of dorsal transscaphoid perilunate fracture-dislocations.J Orthop Trauma, 2008, 22(8):535-540.
6.	Da Fonseca K, Großterlinden L, Rueger JM.Clinical findings and treatment of perilunar dislocations and dislocation fractures.Unfallchirurg, 2012, 115(7):576-581.
7.	Jones DB Jr, Kakar S.Perilunate dislocations and fracture dislocations.J Hand Surg (Am), 2012, 37(10):2168-2173.
8.	Chou YC, Hsu YH, Cheng CY, et al.Percutaneous screw and axial Kirschner wire fixation for acute transscaphoid perilunate fracture dislocation.J Hand Surg (Am), 2012, 37(4):715-720.
9.	Alexa O, Veliceasa B.Percutaneous Herbert screw osteosynthesis in trans-scaphoid perilunate fracture-dislocations.Rev Med Chir Soc Med Nat Iasi, 2013, 117(2):409-413.
10.	Capo JT, Corti SJ, Shamian B, et al.Treatment of dorsal perilunate dislocations and fracture-dislocations using a standardized protocol.Hand (N Y), 2012, 7(4):380-387.
11.	Kannikeswaran N, Sethuraman U.Lunate and perilunate dislocations.Pediatr Emerg Care, 2010, 26(12):921-924.
12.	梅国华, 范存义, 柴益民, 等.复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位.中华手外科杂志, 2010, 26(3):175-178.
13.	Kailu L, Zhou X, Fuguo H.Chronic perilunate dislocations treated with open reduction and internal fixation:results of medium-term follow-up.Int Orthop, 2010, 34(8):1315-1320.
14.	Malović M, Pavić R, Milosević M.Treatment of trans-scaphoid perilunate dislocations using a volar approach with scaphoid osteosynthesis and temporary Kirschner wire fixation.Mil Med, 2011, 176(9):1077-1082.
15.	郭阳, 田光磊, 姜保国, 等.舟骨骨折的螺钉居中固定:生物力学试验.北京大学学报:医学版, 2013, 45(5):684-687.
16.	Hart A, Mansuri A, Harvey EJ, et al.Central versus eccentric internal fixation of acute scaphoid fractures.J Hand Surg (Am), 2013, 38(1):66-71.
17.	Schöll H, Mentzel M, Jones A, et al.Image guidance can support scaphoid K-wire insertion:an experimental study and initial clinical experience.Int J Comput Assist Radiol Surg, 2013, 8(3):471-480.
18.	Garg B, Goyal T, Kotwal PP.Triple jeopardy:transscaphoid, transcapitate, transtriquetral, perilunate fracturedislocation.J Orthop Traumatol, 2013, 14(3):223-226.

1. Sawardeker PJ, Kindt KE, Baratz ME.Fracture-dislocations of the carpus:perilunate injury.Orthop Clin North Am, 2013, 44(1):93-106.
2. Garg B, Goyal T, Kotwal PP.Staged reduction of neglected transscaphoid perilunate fracture dislocation:a report of 16 cases.J Orthop Surg Res, 2012, (7):19.
3. 陈振兵, 洪光祥, 王发斌.上肢功能评定表.中国修复重建外科杂志, 2004, 18(6):520-521.
4. 徐达传, 黄美贤.手舟骨的形态血供特点及其临床意义.中华关节外科杂志(电子版), 2010, 4(2):251-255.
5. Komurcu M, Kürklü M, Ozturan KE, et al.Early and delayed treatment of dorsal transscaphoid perilunate fracture-dislocations.J Orthop Trauma, 2008, 22(8):535-540.
6. Da Fonseca K, Großterlinden L, Rueger JM.Clinical findings and treatment of perilunar dislocations and dislocation fractures.Unfallchirurg, 2012, 115(7):576-581.
7. Jones DB Jr, Kakar S.Perilunate dislocations and fracture dislocations.J Hand Surg (Am), 2012, 37(10):2168-2173.
8. Chou YC, Hsu YH, Cheng CY, et al.Percutaneous screw and axial Kirschner wire fixation for acute transscaphoid perilunate fracture dislocation.J Hand Surg (Am), 2012, 37(4):715-720.
9. Alexa O, Veliceasa B.Percutaneous Herbert screw osteosynthesis in trans-scaphoid perilunate fracture-dislocations.Rev Med Chir Soc Med Nat Iasi, 2013, 117(2):409-413.
10. Capo JT, Corti SJ, Shamian B, et al.Treatment of dorsal perilunate dislocations and fracture-dislocations using a standardized protocol.Hand (N Y), 2012, 7(4):380-387.
11. Kannikeswaran N, Sethuraman U.Lunate and perilunate dislocations.Pediatr Emerg Care, 2010, 26(12):921-924.
12. 梅国华, 范存义, 柴益民, 等.复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位.中华手外科杂志, 2010, 26(3):175-178.
13. Kailu L, Zhou X, Fuguo H.Chronic perilunate dislocations treated with open reduction and internal fixation:results of medium-term follow-up.Int Orthop, 2010, 34(8):1315-1320.
14. Malović M, Pavić R, Milosević M.Treatment of trans-scaphoid perilunate dislocations using a volar approach with scaphoid osteosynthesis and temporary Kirschner wire fixation.Mil Med, 2011, 176(9):1077-1082.
15. 郭阳, 田光磊, 姜保国, 等.舟骨骨折的螺钉居中固定:生物力学试验.北京大学学报:医学版, 2013, 45(5):684-687.
16. Hart A, Mansuri A, Harvey EJ, et al.Central versus eccentric internal fixation of acute scaphoid fractures.J Hand Surg (Am), 2013, 38(1):66-71.
17. Schöll H, Mentzel M, Jones A, et al.Image guidance can support scaphoid K-wire insertion:an experimental study and initial clinical experience.Int J Comput Assist Radiol Surg, 2013, 8(3):471-480.
18. Garg B, Goyal T, Kotwal PP.Triple jeopardy:transscaphoid, transcapitate, transtriquetral, perilunate fracturedislocation.J Orthop Traumatol, 2013, 14(3):223-226.

Chinese Journal of Reparative and Reconstructive Surgery

Kirschner WIRE FIXATION IN THREE JOINTS COMBINED WITH BONE ANCHOR REPAIR FOR TREATMENT OF ACUTE PERILUNATE INJURY

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