Static scapholunate dissociation: a new reconstruction technique using a volar and dorsal approach in a cadaver model.
We used 4 fresh-frozen cadaver arms to assess a method of reconstruction we designed for static scapholunate dissociation. The dorsal scapholunate ligament, scapholunate interosseous ligament, radioscapholunate, and radioscaphocapitate ligaments were sectioned. Radiographs were taken before sectioning, after sectioning, and after reconstruction. Passive motion was also measured before sectioning and after the repair. The dorsal scapholunate ligament was repaired directly; the palmar radioscapholunate and radioscaphocapitate ligaments were reconstructed using a free flexor carpi radialis tendon autograft and Mitek mini suture anchors (1.8-mm diameter and 5.4-mm length; Mitek Products, Norwood, MA) for anatomic fixation. An independent board-certified hand surgeon analyzed the radiographs of the wrists taken before and after sectioning and after reconstruction. Assessment of the unsectioned wrists revealed an average scapholunate angle of 45 degrees. After scapholunate dissociation was created the average scapholunate angle was 71 degrees. Repair of the dorsal scapholunate ligament alone did not improve the scapholunate angle. Average scapholunate angle after repair of the dorsal scapholunate ligament and reconstruction of the palmar ligaments was 43 degrees. Average range of motion on flexion, extension, and radial and ulnar deviation before ligament sectioning and after reconstruction was unchanged at 54 degrees, 59 degrees, 19 degrees, and 40 degrees respectively. This technique shows an improvement in scapholunate angle on lateral radiographs, and passive motion remained relatively unchanged.
Dunn
M J
MJ
Department of Orthopaedic Surgery, Monmouth Medical Center, Longbranch, NJ, USA.
Johnson
C
C
D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012667:Lunate Bone / Q000601:surgery*; D019637:Orthopedic Procedures; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D021361:Scaphoid Bone / Q000601:surgery*; D013536:Suture Techniques; D013710:Tendons / Q000637:transplantation; D014955:Wrist Joint / Q000503:physiopathology