Pediatric and Adolescent Perilunate Injuries: Clinical Presentation, Injury Characteristics, and Outcomes.

Abstract

Fracture dislocations of the carpus are rare, particularly in children. The purpose of this study was to evaluate injury characteristics, clinical presentation, and outcomes of pediatric perilunate injuries. This is a retrospective chart review with a prospective follow-up arm of pediatric patients operatively treated for a perilunate injury at a tertiary care academic center over 12 years (2012-2024). Time to treatment, injury characteristics, surgical details, and complications were collected. Patients were prospectively contacted to return for in-person evaluation, patient-reported outcomes, and radiographs. Descriptive statistics were used for analysis. Fifteen patients qualified with a mean age of 14.2 years, and 87% were men. Mean time to surgery from injury was 27 days, and 67% of patients suffered concomitant injuries from high-energy mechanisms. Mean follow-up time was 12.7 ± 13.7 months, and all injuries involved bony and ligamentous structures. The scaphoid was fractured in 11 of 15 (73%) patients. Patients younger than 10 years presented with a transcapitate pattern. Two patients required an unplanned return to the operating room. Five patients returned for in-person follow-up and had a mean 148° arc of motion, 80% strength compared with the contralateral hand, and were satisfied. All radiographs demonstrated maintained carpal alignment and no evidence of posttraumatic arthritis. Pediatric perilunate injuries are rare and associated with significant delay to treatment. These injuries typically present in teenagers with a transscaphoid pattern and are associated with high-energy mechanisms. Despite treatment delays, patients had good-to-excellent outcomes at greater than 1 year.