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Acute Ligament Repair for SLD

by William Mallon MD 
- Skin Incision:
   
- Identification of Radial Nerve:

 

- Identification of 3-4 Interval:
 

- Longitudinal Arthrotomy:
 

- arthrotomy performed just distal to Lister's tubercle over scapholunate interval; 
- this should provide clear exposure of scaphoid and lunate; 
- alternatively, a distally based capsular flap can be made, which is 1 cm in width and which is centered just radial to the scapholunate interval; - this will be incorporated into a dorsal capsulodesis; 
- Insertion of K wires: 
- reduction of the lunate and scaphoid are performed w/ 0.62 in K wire joysticks inserted in a dorsal to palmar direction; 
- under flourscopic control, two 0.45 in K wires are inserted across the scaphoid, aimed in a position to pass across the scapho-capitate and scapho-lunate intervals; 
- these wires are not driven across the capitate and lunate until the scapholunate interval is repaired; 
 
- Mitek Implants:

 

- 2.0 mm Tacit Threaded Anchor 
- Insertion of Miteks into Scaphoid:
   
- Attachment of Ligament: 
- remant scpaho-lunate ligament usually remains attached to the lunate; 
- a free needle is used to pass Mytek sutures thru the ligament; 
- as an option, the rim of the scaphoid can be roughened w/ a high speed burr; 
 

- Reduction of Scapho-lunate:  
- previously inserted 0.62 in "joy sticks" are manipuated to achieve reduction; 
- previously inserted 0.42 in K wires are driven across the scaphoid into the capitate and lunate; 
- after flouroscopic confirmation of reduction, 0.62 joysticks are removed; 
- Dorsal Capsular Reenforcement: 
- free ends of Mytek suture are then passed thru the dorsal capsule, in order to oppose the capsule to the repaired scapho-lunate ligament;

 

- Intra-Operative X-rays: 

- (the scapho-lunate pin was subsequently withdrawn 2 cm);