Abstract Neglected perilunate fracture–dislocations are uncommon yet disabling wrist injuries, typically resulting from missed diagnoses after high-energy trauma. Chronic cases (>6 weeks' postinjury) present formidable reconstructive challenges due to fibrosis, malalignment, and arthritic change. Although traditional teaching discouraged late reduction, advances in staged distraction, internal fixation, and salvage techniques have redefined management expectations. This systematic review and meta-analysis synthesized available evidence on treatment strategies, functional outcomes, and complications in chronic or neglected perilunate injuries. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, Scopus, Embase, and Web of Science were searched (1983–2025) for studies reporting outcomes of perilunate dislocations treated ≥6 weeks after trauma. Data extracted included patient demographics, injury chronicity, surgical method, and functional results (Mayo Wrist Score, QuickDASH, range of motion, grip strength, and arthritis). A random-effects meta-analysis pooled the proportion of patients achieving “good/excellent” results, whereas heterogeneous data were summarized descriptively. Thirteen studies (158 patients) met the inclusion criteria. Most were young males (mean: 30 years) sustaining high-energy mechanisms; 59% were transscaphoid fracture–dislocations, 30% ligamentous perilunate dislocations, and 11% isolated lunate dislocations. Median delay to treatment was 4.5 months (range: 6 weeks–16 years). Open reduction and internal fixation (ORIF) predominated (49%), followed by proximal row carpectomy (34%) and limited wrist fusion (7%). The pooled proportion of good/excellent Mayo Wrist Scores was 60% (95% confidence interval: 48–72). Mean postoperative flexion–extension arc reached approximately 50% of the contralateral side and grip strength approximately 85%. Radiographic arthritis developed in approximately 28%, but few required later arthrodesis. Staged distraction-assisted reduction improved outcomes in markedly chronic presentations. Even after prolonged delay, selected patients with neglected perilunate fracture–dislocations may achieve meaningful function and pain relief. ORIF within 4 to 6 months appears associated with better functional scores than later reconstruction, whereas very late presentations often necessitate salvage procedures. However, these conclusions are based on very low-certainty evidence from small, heterogeneous observational studies, and should be interpreted with caution Level IV
Jerome et al. (Fri,) studied this question.