Treatment of Perilunate Injuries With Radial-sided Fixation

BACKGROUND: Perilunate dislocations and fracture-dislocations are high-energy wrist injuries. Standard treatment involves urgent closed reduction followed by open reduction and fixation of both radial (scapholunate) and ulnar (lunotriquetral) intervals. In our experience, fixation of the radial-sided injury alone (scaphoid fracture or scapholunate ligament tear) restores carpal alignment without separate lunotriquetral stabilization. We present the largest series to date using this approach. METHODS: Between 2004 and 2025, 36 patients with acute perilunate injuries were treated by a single surgeon with a radial-sided only fixation protocol. All underwent urgent closed reduction, followed by Kirschner wire fixation for ligamentous injuries or headless compression screw fixation for scaphoid waist fractures. Patients were immobilized in a short arm cast for 8 weeks, with wires removed at that time. Radiographs obtained postoperatively and at final follow-up were assessed for scapholunate angle, scapholunate and lunotriquetral intervals, and presence of volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) deformity. RESULTS: All patients achieved stable carpal alignment with radial-sided only fixation. At final follow-up, mean scapholunate angle was 55° (range 34°-84°), mean scapholunate interval 1.8 mm, and mean lunotriquetral interval 1.7 mm. No patients developed VISI deformity. CONCLUSIONS: Perilunate injuries can be effectively managed with fixation limited to the radial side, eliminating the need for lunotriquetral pinning. This series-the largest reported with this technique-challenges traditional dogma derived from Mayfield's description and demonstrates excellent radiographic outcomes with a simplified surgical approach.