Pediatric and Adolescent Perilunate Injuries: Clinical Presentation, Injury Characteristics, and Outcomes.

BACKGROUND: Fracture dislocations of the carpus are rare, particularly in children. The purpose of this study was to evaluate injury characteristics, clinical presentation, and outcomes of pediatric perilunate injuries. METHODS: This is a retrospective chart review with a prospective follow-up arm of pediatric patients operatively treated for a perilunate injury at a tertiary care academic center over 12 years (2012-2024). Time to treatment, injury characteristics, surgical details, and complications were collected. Patients were prospectively contacted to return for in-person evaluation, patient-reported outcomes, and radiographs. Descriptive statistics were used for analysis. RESULTS: Fifteen patients qualified with a mean age of 14.2 years, and 87% were men. Mean time to surgery from injury was 27 days, and 67% of patients suffered concomitant injuries from high-energy mechanisms. Mean follow-up time was 12.7 ± 13.7 months, and all injuries involved bony and ligamentous structures. The scaphoid was fractured in 11 of 15 (73%) patients. Patients younger than 10 years presented with a transcapitate pattern. Two patients required an unplanned return to the operating room. Five patients returned for in-person follow-up and had a mean 148° arc of motion, 80% strength compared with the contralateral hand, and were satisfied. All radiographs demonstrated maintained carpal alignment and no evidence of posttraumatic arthritis. CONCLUSIONS: Pediatric perilunate injuries are rare and associated with significant delay to treatment. These injuries typically present in teenagers with a transscaphoid pattern and are associated with high-energy mechanisms. Despite treatment delays, patients had good-to-excellent outcomes at greater than 1 year.