Outcomes of acute perilunate injuries-a systematic review.

Liechti, Rémy; Merky, Dominique Nellie; Grobbelaar, Adriaan Ockert; van de Wall, Bryan J M; Vögelin, Esther; Hirsiger, Stefanie (2023). Outcomes of acute perilunate injuries-a systematic review. European journal of trauma and emergency surgery, 49(5), pp. 2071-2084. Springer-Medizin-Verlag 10.1007/s00068-023-02222-y

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PURPOSE

The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date.

MATERIAL AND METHODS

This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included.

RESULTS

Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6-7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2-1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1-0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable.

CONCLUSIONS

Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare.

LEVEL OF EVIDENCE

Systematic review of level IV studies.

Item Type:	Journal Article (Review Article)
Division/Institute:	04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Hand Surgery 04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery
UniBE Contributor:	Liechti, Rémy, Merky, Dominique, Grobbelaar, Adriaan Ockert, Vögelin, Esther, Hirsiger, Stefanie Caroline
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1863-9933
Publisher:	Springer-Medizin-Verlag
Language:	English
Submitter:	Pubmed Import
Date Deposited:	08 Feb 2023 09:38
Last Modified:	26 Sep 2023 00:12
Publisher DOI:	10.1007/s00068-023-02222-y
PubMed ID:	36750472
Uncontrolled Keywords:	Open reduction and internal fixation Perilunate dislocation Perilunate fracture-dislocation Perilunate injury Wrist arthroscopy
URI:	https://boris.unibe.ch/id/eprint/178516