Perilunar dislocation of the carpus. A diagnosis still often missed.

A retrospective study of patients with dorsal perilunar dislocation of the carpus (DPD) from seven different centres has been made. There were 91 cases with adequate documentation and radiographs; of these, 61 attended for review between 12 months and 22 years (follow-up average: 42 months). Functional results were assessed by a modified Witvoet score (Witvoet & Allieu, 1973). There were only 33/61 good results. Statistical evaluation disclosed that, whatever the morphology of the initial injury, prognosis had a significant relation to the delay of time between accident and diagnosis (p less than 0.001) to the accuracy of reduction and its maintenance (p less than 0.025) and to the rotation degree of the semilunar bone (p less than 0.001). Authors conclude by saying that there is no problem in DPD itself. The problem exist in the fact that these injuries are still often missed and, subsequently, mismanaged.