Arthroscopically Assisted Mini-invasive Management Of Trans-Scaphoid Perilunate Fracture And Dislocation

Objective:To analyze the preliminary clinical results of treating trans-scaphoid perilunate fracture and dislocation with arthroscopy assisted mini-invasive management.Methods:From May,2014 to Aug,2017.a consecutive series of 8 patients with trans-scaphoid perilunate fracture and dislocation were treated with arthroscopically assisted mini-invasive methods.Among them,6 were male and 2 were female.Age was from 20 to 50,averaged 36.Three were on the left and 5 on the right.All the patient were closed injury and saw the doctor 2 to 12 days after injury,1 week on average.Preoperative translocation X-ray and 3D CT were confirmed to be fracture and dislocation,MRI examination was performed to assess the soft tissue of the wrist.3 cases were found to be combined with triangular avulsion fracture,2 cases of suspected TFCC injury,1 case of fracture of radial styloid process,and 3 cases of ulnar styloid fracture.According to the specific injury situation of each case,it was decided whether to fix the wrist joint and corresponding collateral damage.The results of the last follow-up were referred to as reference data.Postoperative evaluations included measurement of clinical(grip strength and range of motion),radiographic,and functional assessment(modified Mayo wrist score).Results:All 8 cases were examined by arthroscopy(8 cases of scapholunate interosseous ligament and lunotriquetra ligament injury,3cases of radioscaphocapitate ligament injury,2 cases of triquetrohamocapitate ligament injury,2 cases of STT injury,3 cases of avulsion fracture of the triangle,2 cases of TFCC injury,1 case of radial styloid fracture,3 cases of ulnar styloid fracture)and followed for 4 to 11 months(average of 6.5 months).All the scaphoid were healed with 7 to 10 weeks.(average healing time of 8.7 weeks)which is comfirmed with X-ray.The average daily working time was 4.2 months.Results of the latest follow-up of 8 patients: Wrist flexion 58 ° ~ 74 °,an average of 63.3 °;Wrist extension 54 ° ~ 61 °,an average of 56.3 °;Radial deviation 16 ~ 20 °,an average of 18.3 °;Ulnar deviation 22 ° to 30 °,an average of 25.3 °;scapholunate angle 46 ~ 52 °,an average of 48.9 °;Radiolunate angle 4 ° ~ 10 °,an average of 6.4 °;Scapholunate Joint Space 0.5 ° ~ 1.5 °,an average of 0.95 °;lunotriquetral Joint Space 0.5 ~ 0.9 °,an average of 0.65;The grip strength recovered to the healthy side 87%~95%,average 91.4%;Range of motion 114 ° ~ 135 °,with an average of 119.6 °.The result was excellent in 6 cases,good in 2 cases according to the modified Mayo wrist score.Conclusion:When properly indicated,Arthroscopically Assisted Mini-invasive management of Trans-Scaphoid Perilunate Fracture and Dislocation that is a reliable and favorable alternative for particular advantages can accurate reduction and fracture dislocation and check and treat the soft tissue injuries(such as scapholunate interosseous ligament,lunotriquetra ligament,TFCC,etc).It can reduce the complications of wrist instablility,complex regional pain syndrome,and traumatic arthritis.