Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest.
BACKGROUND
To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest.


METHODS
In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks.


RESULTS
Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was -10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured -2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O'Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique.


CONCLUSIONS
The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging.
Lutz
M
M
Department of Trauma Surgery, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. martin.lutz@uklibk.ac.at
Kralinger
F
F
Goldhahn
J
J
Zimmermann
R
R
Rudisch
A
A
Gabl
M
M
Pechlaner
S
S
D016025:Bone Transplantation / Q000379:methods; D006801:Humans; D007085:Ilium / Q000637:transplantation; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008022:Ligaments / Q000293:injuries* / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000150:complications / Q000601:surgery*