Tchaa Hodabalo Towoezim, Akawoulou K Victore Agbao, Batarabadja Bakriga, Yaovi Yanick Dellanh, Gamal Ayouba, Anani Abalo
In this small Level IV case series, isolated K-wire stabilization without formal ligament repair was associated with heterogeneous mid-term outcomes after acute PLD and fracture-dislocations. Partial functional recovery was observed in many patients, but residual scapholunate malalignment persisted in some cases. These findings are descriptive and hypothesis-generating and should be interpreted cautiously in the absence of a comparative cohort. They should not be viewed as evidence of equivalence to ligament-repair techniques.
BACKGROUND: Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are uncommon but severe carpal injuries. Although open or arthroscopic-assisted reduction with capsuloligamentous repair is recommended when feasible, access to suture anchors, appropriate nonabsorbable sutures, wrist arthroscopy, and advanced imaging may be inconsistent in resource-limited trauma settings. In such circumstances, temporary K-wire stabilization without formal ligament repair may represent a pragmatic stabilization strategy.
METHODS: We retrospectively reviewed 11 consecutive patients with acute PLD or PLFD treated between July 2019 and June 2024 in a single-center retrospective therapeutic case series (Level IV evidence). All patients underwent attempted fluoroscopic closed reduction followed, when necessary, by open reduction. Stabilization consisted of scapholunate and lunotriquetral pinning using two 1.6-mm K-wires, without formal ligament repair; associated fractures were fixed with K-wires as indicated. Outcomes included pain (VAS), QuickDASH, PRWE, Mayo Wrist Score (MWS), wrist range of motion, and grip strength. Radiographs assessed scapholunate distance (SLD) and scapholunate angle (SLA).
RESULTS: Mean age was 36.9 years and 81.8% of patients were male. All injuries resulted from high-energy trauma (nine road-traffic accidents and two sports-related injuries). Five patients had PLD and six had PLFD. Closed reduction was successful in three cases; eight required open reduction (six dorsal and two combined dorsal-volar). Mean follow-up was 50.5 months. Mean VAS was 3. Mean QuickDASH was 30.4, PRWE 37.5, and MWS 78.5. Mean flexion-extension arc was 101.8° and mean grip strength was 75.2% of the contralateral side. Mean SLD was 3.0 mm and mean SLA was 61.8°. No pin-tract infection, K-wire migration, avascular necrosis, or radiographic osteoarthritis was observed at mid-term follow-up.
CONCLUSION: In this small Level IV case series, isolated K-wire stabilization without formal ligament repair was associated with heterogeneous mid-term outcomes after acute PLD and fracture-dislocations. Partial functional recovery was observed in many patients, but residual scapholunate malalignment persisted in some cases. These findings are descriptive and hypothesis-generating and should be interpreted cautiously in the absence of a comparative cohort. They should not be viewed as evidence of equivalence to ligament-repair techniques.