by William Mallon MD
- Skin Incision:
- Identification of Radial Nerve:
- Identification of 3-4 Interval:
- 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;
- (the scapho-lunate pin was subsequently withdrawn 2 cm);