Journal List > Arch Hand Microsurg > v.23(3) > 1106617

Lee, Kang, Jung, and Lee: Surgical Treatment of Scapholunate Instability

초록

The incidence of ligament injuries of the wrist has increased due to sports activities. However, diagnosis and management of these injuries are sometimes difficult because of the anatomic complexity and variable injury patterns. The scapholunate ligament is both a key ligament in the stability of the carpus and one of the most frequently injured. The presentation of scapholunate instability often includes a vague injury history and pain with grip, wrist extension, and sport or labor. To properly diagnose and manage these conditions, thorough understanding of the wrist anatomy and physical and radiologic examination is mandatory. This article will briefly discuss the wrist joint anatomy and biomechanics, and review the diagnosis and surgical management of the scapholunate ligament injury.

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Fig.1.
Radiologic findings of the scapholunate dissociation. Wide scapholunate gap, cortical ring sign in the posteroante-rior view and dorsal intercalated segmental instability pattern in the lateral view can be seen.
ahm-23-139f1.tif
Fig.2.
Arthroscopic thermal shrinkage. (A) 42-year-old female patient's left wrist radiocarpal arthroscopy image shows focal dorsal synovitis. (B) Same patient's midcarpal arthroscopy image shows Geissler grade II scapholunate instability (Sca: scaphoid, Lu: lunate). (C) Same patient's midcarpal arthroscopy image shows thermal shrinkage on the volar scaphoilunate interosseous ligament and volar carpal ligament.
ahm-23-139f2.tif
Fig.3.
Modified three-ligament tenodesis using flexor carpi radialis (FCR) tendon. (A) Visible gap between scaphoid and lunate, (B) harvesting the half-slip of FCR tendon, (C) tendon passed through scaphoid bone tunnel, (D) tendon sutured to the lunate and dorsal intercarpal ligament.
ahm-23-139f3.tif
Fig.4.
Antipronation spiral tenodesis using Palmaris longus free tendon graft. (A) Pre-operative X-ray shows static scapholunate dissociation and dorsal intercalated segmental instability defor-mity. (B) The dorsal ligamentous linkage between scaphoid and triquetrum is reestablished by pal-maris longus (PL) graft. (C) Distal stump of PL graft is fixing at scaphoid bone tunnel with bio-composite interference screw. (D) Postoperative X-ray shows reduction of scapholunate dissociation.
ahm-23-139f4.tif
Table1.
Arthroscopic EWAS staging of scapholunate interosseous ligament ruptures
Stage Description Arthroscopic testing of scapholunate joint from the radial midcarpal portal
I Elongation No passage of the probe
II Rupture of the proximal SL membrane Passage of the tip of the probe in the SL space without widening
IIIA II+disruption of the volar SL ligament Volar SL joint widening when tested with the probe (anterior laxity)
IIIB II+disruption of the dorsal SL ligament Dorsal SL joint widening when tested with the probe (posterior laxity)
IIIC II+rupture of the volar and dorsal SL ligaments Global widening of SL space, reducible with removal of probe
IV IIIC+SL gap (no misalignment) SL diastasis without radiographic abnormalities; arthroscope may enter the radiocarpal space
V IV+carpal malalignment Wide SL gap with radiographic anomalies

EWAS: European Wrist Arthroscopy Society, SL: scapholunate.

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