Dear Editor
We read the article by Bagheri et al with great interest (1). We found the study interesting and comprehensive as four groups of patients, including operative and nonoperative in either pure dislocation or fracture dislocation, were compared in terms of Mayo wrist score, Grip strength, range of motion and radiographic parameters. It seems that the results were comparable to studies by Capo, Chou, Laporte, Malovic, Kremer, Forli and Lutz (1) (2-8).
Table 1.
studies around the world on the results of operative treatment after perilunate dislocation (PLD) and perilunate fracture dislocation (PLFD)
| Authors | Year | Country | Op. vs. Non-op | No. of patients | Average F/U | Mayo score | PRWE score | DASH score | DJD | Arc of flex-ext | Grip strength | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bagheri et al (1) | 2013 | Iran | Non-op | PLD | 5 | 70.32 m | 71 | 2 | 98.1° | |||
| Non-op | PLFD | 9 | 69 m | 71.1 | 3 | 96.6° | ||||||
| Op. | PLD | 6 | 62.4 m | 85 | 3 | 101.66° | ||||||
| Op. | PLFD | 14 | 65.4 m | 87.7 | 4 | 109.28° | ||||||
| Capo et al (2) | 2012 | NJ, USA | Op. | PLD | 13 | 6 m< | 40/100 | 13 | 86° | 59% | ||
| Op. | PLFD | 12 | 78° | |||||||||
| Chou et al (3) | 2012 | Taiwan | Op. | PLFD | 24 | 45 m | 83 | 144° | 84% | |||
| Laporte et al (4) | 2012 | France | Op. | PLD | 6 | 26 m | 41 | 24.6/55 | 101° | 71% | ||
| Op. | PLFD | 11 | ||||||||||
| Malovic et al (5) | 2011 | Croatia | Op. | PLFD | 43 | 29 m | 87 | |||||
| Kremer et al (6) | 2010 | Germany | Op. | PLD | 9 | 66 m | 70 | 20 | 77° | 70% | ||
| Op. | PLFD | 30 | ||||||||||
| Forli et al (7) | 2010 | France | Op. | PLD | 11 | 13 y | 77 | 13 | 8 | 94° | 87% | |
| Op. | PLFD | 7 | 13 y | 74 | 35 | 4 | 98° | 87% | ||||
| Lutz et al (8) | 2009 | Austeria | Op. | PLD | 15 | 5 y | 81.5 | 20.7 | 80-85% | |||
| Op. | PLFD | 10 | 5 y | 82.7 | 27.7 | |||||||
| F/U=follow-up, PRWE=Patient-Rated Wrist Evaluation, DASH=Disabilities of the Arm Shoulder and Hand | ||||||||||||
| DJD=Degenerative Joint Disease, Non-op=Non-operative, Op=Operative | ||||||||||||
In the studies listed above, all the patients were treated by operative fixation and none of them reported any experience with non-operative treatment (2-8). Their operative results are almost similar to Bagheri’s operative results in which they demonstrated better outcomes in terms of motion and Mayo score than the non-operative counterpart.
In the current study by Bagheri et al, non-operative treatment is also discussed, which has little literature support so far (1). We wonder what the indications were leading the patient and the surgeon electing nonoperative treatment versus operative intervention. Since the outcomes of non-operative care were comparable to the operative outcomes, weighing the benefits of non surgical management may be an area of further investigation.The authors didn’t describe the operative intervention in detail making comparisons with outer studies difficult. Therefore, we note the need to compare different operative techniques in the literature to figure out which provide the most optimal outcomes and expedite patients’ rehabilitation.
References
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