Arthroscopic Management of Perilunate Injuries

Perilunate injuries are highly unstable carpal dissociations characterized by a complete loss of contact between the lunate and surrounding carpal bones. Early anatomical reduction and preservation of carpal alignment until healing are mandatory for a successful outcome. Closed reduction and cast treatment of perilunate dislocations (PLDs) and perilunate fracture dislocations (PLFDs) can result in unacceptably poor outcomes. To reduce morbidity, arthroscopic assisted treatment of PLDs and PLFDs minimizes capsular and adjacent soft tissue injury, while facilitating accurate anatomic reduction and percutaneous fixation of the carpus. This therefore encourages healing with reduced stiffness and improved outcomes compared to similar open procedures. In this chapter, we discuss the surgical techniques of the arthroscopic treatment of PLDs and PLFDs.