Less is More in Acute Perilunate Injuries? Early Success with Arthroscopic-Assisted Fixation of the Proximal Row Without Ligament Repair

To evaluate the short-term safety and clinical effectiveness of arthroscopic-assisted reduction with percutaneous proximal-row stabilization performed without intrinsic ligament repair for acute perilunate injuries. Patients with acute, isolated perilunate injuries treated by a single surgeon between 2021 and 2025 were prospectively enrolled. All underwent arthroscopic-assisted reduction and percutaneous proximal-row stabilization without intrinsic ligament repair. Clinical evaluation included objective functional assessment and patient-reported outcome measures. Radiographic analysis included measurement of the scapholunate interval, scapholunate, radiolunate and radioscaphoid angles, dorsal scaphoid translation, fracture union, and presence of degenerative changes. Ten male patients (36 ± 14 years) were treated at a mean of 5 ± 3 days post-injury; 40% presented with median neuropathy. Eight injuries were Mayfield stage III and two stage IV, with five fracture–dislocation patterns. At a mean 14-month follow-up, patients demonstrated favorable early outcomes (Disabilities of the Arm, Shoulder and Hand score 7 ± 10, Modified Mayo Wrist Score 89 ± 7, Patient-Rated Wrist Evaluation 14.6 ± 15.1, and Visual Analog Scale pain score 0.4 ± 1), near-symmetric motion and grip strength, and maintained radiographic alignment (mean scapholunate gap 2.3 ± 0.8 mm). All fractures united, there were no post-operative complications, and all manual laborers returned to unrestricted work at 28 ± 16 weeks. Arthroscopic-assisted reduction and percutaneous proximal-row fixation without ligament repair appears feasible and safe, yielding excellent short-term functional and radiographic outcomes with minimal morbidity. Larger studies with longer follow-up are needed to determine long-term durability. Level IV.