Abstract：
OBJECTIVE: This study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature.
METHODS: A total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides.
RESULTS: Among the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo\'s wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures.
CONCLUSIONS: Staged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures.
METHODS: 4.
METHODS: A total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides.
RESULTS: Among the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo\'s wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures.
CONCLUSIONS: Staged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures.
METHODS: 4.
摘要：
目的：本研究旨在使用单阶段评估切开复位内固定（ORIF）治疗慢性骨周脱位的结果，两阶段,和打捞程序。该研究还将这些方法相互比较，并与现有文献的结果进行比较。
方法：将2013年至2019年的15例慢性牙周炎损伤患者纳入研究。术前和术后评估使用平片进行，选择性地进行CT扫描以进行详细的形态和断裂模式分析。在患者中,13接受ORIF，而2人接受了打捞程序。在ORIF案件中，对4例患者进行了单阶段手术，以及9例患者的两阶段手术。外部固定器,包括单侧单平面外固定器（UUEF）和双侧单平面外固定器（BUEF），分别应用于5名和4名患者，分别。多年来，我们治疗慢性perilunate损伤的方法不断发展。我们从单阶段ORIF开始，然后逐步进行两个阶段的手术，最初使用外部固定器作为仅在radial侧施加的腕骨撑开器，最后使用在radi侧和尺侧的外部固定器进行双侧腕骨撑开。
结果：在15名患者中，3人失去了随访。其中,一个接受了四角融合，而其余两人有UUEF。受伤和手术之间的平均时间间隔为3.60个月。术后平均肩胛骨角度52.46°,在两名患者中观察到负射线角（表明屈曲），而其他人则显示为正角度（表示延伸）。2例显示舟骨骨不连和血管坏死（AVN），而一个病例出现了lunateAVN。在4例和2例患者中观察到中腕和放射性腕关节关节炎，分别。使用Mayo的腕部评分对两阶段BUEF病例进行了评估，对UUEF和单阶段手术进行了评估。
结论：与UUEF相比，利用BUEF进行阶段性减少，然后进行开放减少已证明效果更好，单阶段开放还原和打捞程序。
方法：4.
方法：将2013年至2019年的15例慢性牙周炎损伤患者纳入研究。术前和术后评估使用平片进行，选择性地进行CT扫描以进行详细的形态和断裂模式分析。在患者中,13接受ORIF，而2人接受了打捞程序。在ORIF案件中，对4例患者进行了单阶段手术，以及9例患者的两阶段手术。外部固定器,包括单侧单平面外固定器（UUEF）和双侧单平面外固定器（BUEF），分别应用于5名和4名患者，分别。多年来，我们治疗慢性perilunate损伤的方法不断发展。我们从单阶段ORIF开始，然后逐步进行两个阶段的手术，最初使用外部固定器作为仅在radial侧施加的腕骨撑开器，最后使用在radi侧和尺侧的外部固定器进行双侧腕骨撑开。
结果：在15名患者中，3人失去了随访。其中,一个接受了四角融合，而其余两人有UUEF。受伤和手术之间的平均时间间隔为3.60个月。术后平均肩胛骨角度52.46°,在两名患者中观察到负射线角（表明屈曲），而其他人则显示为正角度（表示延伸）。2例显示舟骨骨不连和血管坏死（AVN），而一个病例出现了lunateAVN。在4例和2例患者中观察到中腕和放射性腕关节关节炎，分别。使用Mayo的腕部评分对两阶段BUEF病例进行了评估，对UUEF和单阶段手术进行了评估。
结论：与UUEF相比，利用BUEF进行阶段性减少，然后进行开放减少已证明效果更好，单阶段开放还原和打捞程序。
方法：4.
