- Discussion: - injury mustoccur to both interosseous and capsular ligaments for rotationalinstability 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 interval; - 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 scapholunatedissociation: ligamentous repair associated with modified dorsal capsulodesis.