Proximal row carpectomy versus open reduction and internal fixation in late-presenting perilunate dislocations

• Late-presenting perilunate injuries remain a clinical challenge with no consensus treatment. • This multicenter study compares proximal row carpectomy (PRC) versus ORIF outcomes. • PRC offers faster early pain relief and disability improvement compared with ORIF. • ORIF provides greater long-term grip strength at 12 months. • Both procedures yield comparable overall functional recovery at one year. Perilunate dislocations and fracture-dislocations are severe wrist injuries, frequently caused by high-energy trauma, that can lead to long-term complications if not promptly addressed. While early open reduction and internal fixation (ORIF) is the standard treatment for acute injuries, the optimal management of late presentations remains controversial. This study aims to compare the clinical outcomes of proximal row carpectomy (PRC) with those of ORIF in patients with late-presenting perilunate injuries. This retrospective comparative study analyzed data from three hand trauma centers in Italy. Patients with perilunate injuries presenting more than four weeks post-injury were included and treated with either PRC or ORIF. Clinical outcomes, including Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores, pain scores according to a Visual Analog Scale (VAS), wrist range of motion, and grip strength, were assessed pre-operatively and at 3, 6, and 12 months post-operatively. Patient allocation was non-randomized and based on surgeon judgment and intra-operative findings Twenty-seven patients were included (11 PRC, 16 ORIF). Both procedures resulted in significant improvements in pain and function. At 3 months, PRC showed lower disability and pain scores compared with ORIF (DASH 34.1 vs 43.1; VAS 2.18 vs 3.06). At 12 months, outcomes were comparable, with greater wrist flexion after PRC (49.1 ° vs 44.1 °) and greater grip strength after ORIF (28.1 vs 23.6 kg). In late-presenting perilunate injuries, PRC is a viable surgical option, offering faster early recovery and comparable long-term outcomes to ORIF. While ORIF may provide superior grip strength, PRC is advantageous for early pain relief and flexion recovery.