Scapholunate Ligamentous Repair
Anatomy
Indications
- Acute scapholunate instability
- Subacute scapholunate instability
Contraindications
- Radioscaphoid arthritis
- Capitolunate arthritis
- Chronic scapholunate instability
Alternatives
Pre-op Planning / Special Considerations
- Have mini-anchors available (2.4mm). See manufacture links for available anchors.
Technique
- Pre-op antibiotics.
- Supine position with hand table.
- Anesthesia (regional or general)
- EUA compare to uninjured side.
- Touniquet high on arm.
- Consider Wrist Arthroscopy to confirm diagnosis and examine for arthritic changes.
- Dorsal longitudinal incision just ulnar to Lister's Tubercle.
- Step-cut insicion in the extenosr retinacular over the 4th dorsal compartment.
- Consider posterior interosseous nerve neurectomy.
- Transverse incision in capsule just proximal to the dorsal intercarpal ligament. Extend the incision proximally and radially along the radial aspect of the radiocarpal ligament as needed.
- Indentify the scapholunate interosseous ligament. It is typically avulsed from its scaphoid insertion.
- Evaluate the dorsal intercarpal ligament for injury to its lunate of scaphoid insertions.
- Evaluate for any chondral injury.
- Reduce scapholunate joint anatomically. The scaphoid is typically flexed and the lunate is typically extended. K-wires may be needed to aid in the reduction.
- Place 1or 2 0.045 k-wires from radial to ulnar across the scapholunate joint and 1 -.045 K-wires from ulnar to radial across the triquetrolunate joint to maintain the reduction.
- Place mini-suture anchors (2.0-3.0mm) to anatomically restore the scapholunate interosseous ligament and dorsal intercarpal ligament.
- Irrigate.
- Repair the capsule and extensor retinaculum.
- Repair in layers.
Complications
- Loss of reduction
- Pin track infection
-
Follow-up care
- Long-arm splint in pronation for 4-6 weeks, with frequent follow-up xrays to assess reduction.
- At 6 week follow-up change to short-arm splint.
- K-wires are removed at 10-12weeks.
- Consider occupational therapy if stiffness continues one month after pin removal.
Outcomes
Review References
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