Artikel
Perilunate fractures and perilunate dislocations in polytrauma
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Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Generally there is a high rate of missed or incorrect diagnosis for perilunate (fracture) dislocations (PD). Especially in severe injured or polytrauma patients the focus of diagnosis and treatment is restoring vital functions, therefore wrist injuries are sometimes diagnosed or treated later. Thus the aim of this study was to analyze the diagnosis, management and outcome of PLF in polytrauma patients in our Level I Trauma Center.
Methods: In this retrospective study all PD in polytrauma between 10/1994 and 09/2017 were included. All 17 patients with a mean age of 36.1 years (range: 17.2-61.1) were male. The mechanism of injury included falls from > 3 meter in ten cases, < 3 meter in three cases and traffic accidents in four cases. The mean injury severity score was 40 (range: 25-75). Most cases (12) were initially diagnosed by conventional x-ray (Gilula-lines, SL-gap,) and by CT scan. In 3 cases it was diagnosed later at an average of 7 days (1-49). 2 patients were transferred to us from another centre.
Results and Conclusions: From the 17 patients one died in the OR, thus 16 were treated surgically.
Reasons for late or alternative care were: precarious soft tissue situation, severe SHT, delayed diagnosis and exitus letalis. We found two cases of persistent carpal instabilities. Range of motion (ROM) will be presented.
Closed reduction should be performed acutely, followed by open reduction and ligamentous and bony repair with internal fixation, whenever possible. In the special setting of polytrauma life threating injuries are of course prioritized influencing the outcome of these severe wrist injuries.