Outcome assessment of two stage reduction and fixation in neglected trans scaphoid peri lunate fracture dislocation

Background: Perilunate instability is a type of carpal instability complex. Perilunate injuries occur after high-energy traumas to the wrist or falls on the outstretched hand.Methods: The hospital based prospective study was held in the department of Orthopaedics, SMS medical college and Hospital, Jaipur from April 2016 to November 2017. It included 25 cases of neglected trans scaphoid peri lunate fracture dislocation treated in 2 stages surgical procedures.Results: Median nerve was involved in 6 (24%) patients. Pain was also graded as subjective pain. Most of patients had pain free wrist at 1 year follow up post surgery while 2 patients had pain on routine activity, 5 patients had pain on sternous activity and pain was permanent in 1 patient. Mean scapholunate and radiolunate angles were 54 degrees (range 40 to 60 degrees) and 9.8 degrees (range 5 to 15 degrees) on the immediate postoperative radiographs and 54.8 degrees (range 40 to 65 degrees) and 10.6 degrees (5 to 20 degrees) at 1 years follow up. Mild degenerative changes were seen in the radiocarpal joint in 3 patients and in midcarpal joint in 4 patients one patient had both radiocarpal joint arthritis and midcarpal joint arthritis two patients developed superficial pin tract infection.Conclusions: On the basis of our study we finally conclude staged reduction should be considered for neglected trans scaphoid peri lunate dislocations