Timing and Injury Severity as Potential Determinants of Patient-Reported Outcomes After Perilunate Injuries: A Prospective Single-Center Cohort Study

Background/Objectives: Perilunate dislocations (PLDs) and perilunate fracture-dislocations (PLFDs) are uncommon but severe wrist injuries for which the prognostic influence of treatment timing and initial injury severity remains incompletely defined. This prospective study investigated the association between time to definitive surgery and patient-reported functional outcome and explored clinical and radiographic factors potentially influencing recovery. Methods: Thirty consecutive patients with perilunate injuries were screened at a specialized hand surgery referral center between June 2022 and June 2025. Twenty-five patients completing a minimum 12-month follow-up were included. Clinical outcomes included range of motion (ROM), grip strength, Mayo Wrist Score (MWS), and Patient-Rated Wrist Evaluation (PRWE). Radiographic assessment included scapholunate (SL) gap, carpal height ratio, and SL angle. Associations between treatment timing, radiographic variables, and final PRWE were explored using Spearman correlation and sensitivity analyses. Results: Wrist ROM improved significantly throughout the first postoperative year (all p < 0.0001). Median MWS improved from 70 to 80 (p = 0.0004), while PRWE decreased from 25.75 to 10.5 (p = 0.0002). At 1 year, grip strength reached a median 79% of the contralateral side. Longer time to definitive surgery was associated with worse final PRWE (ρ = 0.578, p = 0.012); this association persisted after exclusion of the most delayed case but disappeared when analysis was restricted to patients treated within 7 days (ρ = 0.111, p = 0.706). Greater preoperative SL gap was also associated with worse final PRWE (ρ = 0.517, p = 0.028), whereas final SL gap was not. Final outcomes did not significantly differ among the principal injury patterns. Conclusions: Perilunate injuries showed substantial functional recovery during the first postoperative year. Marked treatment delay and greater initial scapholunate disruption, rather than injury pattern alone, were associated with worse patient-reported outcome. These findings support prompt diagnosis and timely definitive reconstruction and suggest that quantitative measures of initial injury severity may provide prognostic information beyond conventional PLD/PLFD classification.