Vol.:(0123456789) 1 3 Eur J Trauma Emerg Surg DOI 10.1007/s00068-017-0856-9 ORIGINAL ARTICLE The treatment of perilunate ligament injuries in multiply injured patients K. V. Brown 1  · D. Tsekes 1,2  · C. G. Gorgoni 1  · L. Di Mascio 1   Received: 27 May 2017 / Accepted: 30 September 2017 © Springer-Verlag GmbH Germany 2017 reduction and neurological decompression followed by subsequent accurate defnitive fxation leads to good out- comes. A delay of defnitive fxation of up to 18 days does not appear to have a deleterious efect on outcome. Keywords Perilunate · Injury · Polytrauma · Treatment Introduction Perilunate dislocations (PLD) and fracture-dislocations (PLFD) are rare [ 1]. They have been previously well described with regards to their presentation, classifcation of the fracture morphology [2–7] and appropriate manage- ment [2, 8–12]. Outcomes are improved by early diagnosis and treatment [3, 9, 13, 14]. The mechanism of injury is usually one of high energy and it has been previously noted that up to 26% of these patients present with polytrauma [3]. To date, case series have been published from specialist hand units with no detailed description of associated limb or torso injuries. This is the frst documented review of a series of these injuries in a Major Trauma Centre in the UK. Our frst aim was to evaluate our treatment algorithm for these injuries using patient-related outcome measures, well-estab- lished radiological parameters and clinical examination. Considering that a large percentage of these patients will present with severe concomitant or life threatening injuries (in our series 45%) and the importance given to perilunate injuries management may lose priority, we aimed to deter- mine whether concomitant injuries would impair the fnal wrist functional outcome. We also hypothesised that delay to defnite treatment of these injuries would not afect the outcome. All wrists were classifed according to Herzberg [3] and their management was assessed. The outcomes were further compared to those achieved in previous studies and Abstract Purpose Perilunate injuries are rare, severe injuries of the carpus. They can present as isolated injuries or in the poly- traumatised patient. This is the frst documented series of these injuries treated in a Major Trauma Centre. The aims were to assess the management, treatment algorithm and outcomes, of perilunate injuries in our department, review whether concomitant polytrauma afected those outcomes and identify if delay to defnitive treatment had a signifcant efect on overall outcome. Methods Perilunate injuries admitted to the Royal London Hospital between Oct 2011 and March 2016 were identifed. All defnitive surgical procedures were per formed by the senior author; hand therapists supervised patient rehabilita- tion. Outcomes were assessed by Mayo Wrist and Quick- DASH scores. Results We identifed 23 perilunate injuries (22 patients). There was an associated nerve injury in 10 cases with other system injuries present in 12 cases. At fnal review, the mean carpal height ratio was 0.56, Mayo Wrist score was 81 and QuickDASH score was 16.4. There were no difer- ences when comparing the outcomes of patients who had early against those with more delayed defnite treatment or when comparing patients with isolated wrist injuries against polytrauma patients. Conclusion Satisfactory outcomes can be achieved, even in the presence of other injuries, if initial treatment is prompt and follows a clear management protocol. Prompt early * D. Tsekes dtsekes@nhs.net 1 Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London E1 1BB, UK 2 18 Chandos Court, London N147AA, UK