Anatomical landmarks to define a safe zone for percutaneous K-wire fixation in acute peri lunate dislocations with a diamond configuration: A cadaveric correlation

Purpose: The primary objective of this study was to establish the anatomical landmarks intra-operatively to serve as safe zones at the wrist joint during percutaneous K-wire fixation of closed perilunate dislocation(PLD). The study then correlated the same landmarks in cadavers to look for potential neurotendinous injuries. Methods: A cohort of 10 individuals with closed acute peri lunate dislocation underwent closed reduction and percutaneous K-wire pinning. We identified the precise locations for the K-wire entrance and the angle of trajectory for a diamond construct using prominent bone landmarks. We subsequently repeated the process on five cadaveric wrists to establish the accuracy of landmarks and safety of trajectory. We assessed the correctness of the K-wire trajectory using radiographic imaging. The five cadaveric wrists were later dissected to determine the precise trajectory of the K-wire and ascertain whether critical structures like the superficial radial nerve, the dorsal sensory ulnar nerve and the extensor tendons were compromised during the procedure. The clinical cohort was examined for any postoperative complications related to the K-wire placement postoperatively. Results: With well-defined anatomical landmarks and a constant angular trajectory, we could achieve the diamond construct in all the cases of acute PLD. We avoided injury to the vital structures and confirmed the safety of these landmarks with the cadaveric correlation. None of the patients exhibited any sensory loss or pain and or any finger or wrist extension deficits postoperatively. Conclusion: The anatomical described landmarks have produced a consistent fixation pattern and would help surgeons mark the entry points with great accuracy while performing closed reduction of acute PLD.