The Hip: Preservation, Replacement and Revision

Scapholunate Ligament Repair:   

- Discussion:
   - injury must occur to both interosseous and capsular ligaments for rotational instability of the scaphoid to occur;
   - dorsal approach to the wrist:
   - reduce scaphoid into the extended position;
          - surgeons gloved finger presses the distsal pole of scaphoid into an extended position;
          - K wire is inserted across the scapho-capitate interval while the scaphoid is held in the extended position;
   - reduce lunate out of DISI position;
          - K wire can be directly inserted into the lunate (dorsal to volar direction);
          - K wire is then pulled dorsally and angled superiorly (which brings the lunate into a reduced position)
   - scapholunate interval is reduced;
          - tenaculum clamp is used to directly compress the scapholunate interval;
          - K wire is inserted across the scapholunate and SC intervals;
                 - references:
                       - Kirschner wire fixations for scapholunate dissociation: a cadaveric, biomechanical study.
                       - The use of temporary screw augmentation for the treatment of scapholunate injuries
   - bone anchors insertion:
          - bone anchors are inserted into the distal aspect of the scaphoid and lunate;
   - SL ligament is repaired:
   - capsulodesis augmentation is added if needed
          - references:
                 - Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma.
                 - Treatment of scapholunate dissociation: ligamentous repair associated with modified dorsal capsulodesis.

    - reference:
            - Biomechanical Analysis of Scapholunate Ligament Repair Techniques
            - Repair and/or reconstruction of scapholunate interosseous ligament in lunate and perilunate dislocations.
            - Treatment of scapholunate dissociation. Rotatory subluxation of the scaphoid.
            - Scapholunate interosseous reconstruction and imbrication of palmar ligaments.
            - Preliminary lunate reduction and pinning facilitates restoration of carpal height when treating perilunate dislocation, scaphoid fracture and nonunion, and scapholunate dissociation. 
            - Capsulodesis of the wrist for scapholunate dissociation.
            - Capsulodesis for the treatment of chronic scapholunate instability.
            - Three-Ligament Tenodesis for the Treatment of Scapholunate Dissociation: Indications and Surgical Technique.
            - Treatment of acute scapholunate ligament injuries with bone anchor.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, June 28, 2016 7:02 pm