[Therapy for static scapholunate instability -- reconstruction of the dorsal part of the scapholunate ligament with a periosteal flap of the iliac crest].
Recurrent instability is frequent following capsulodesis, tenodesis, or ligament reconstruction in static scapholunate instability. Therefore a periosteal flap of the iliac crest was designed to reconstruct the dorsal part of the SL ligament, which is known to be the biomechanically strongest portion and also the axis of rotation between the scaphoid and lunate. Biomechanical testing of ten fresh frozen dorsal SL ligaments and ten periosteal flaps of the iliac crest showed similar properties concerning failure force, failure displacement, failure stress, energy to failure and stiffness. Results of eight specimens in each group were available following successful testing. Failure force of the dorsal SL ligament was 171.8 N (SD 44.2), energy to failure amounted 269.1 N-mm (SD 98.9), failure stress was 10.3 N/mm (2) (SD 1.3), failure displacement 2.9 mm (SD 0.4), and stiffness 77.2 N/mm (SD 21.4). Testing of the periosteal flap gave the following values: failure force 144.3 N (SD 38.7), energy to failure 217.9 N-mm (SD 85.0), failure stress 9.9 N/mm (2) (SD 1.7), failure displacement 3.0 mm (SD 0.4) and stiffness 60.5 N/mm (SD 14.7). In addition to these test values, clinical and radiological data of eleven patients were available following reconstruction of the dorsal SL ligament with a periosteal flap of the iliac crest. The interval between trauma and surgery was 15 months, mean follow-up was 29 months. One patient was free of pain, whereas ten mentioned pain during or following strenuous work. Two patients were completely satisfied, nine complained about some restriction during special activities. Active range of motion amounted to 56 degrees extension, 46 degrees flexion, 17 degrees radial abduction, 30 degrees ulnar abduction. Grip strength was 38.5 kg, which was 79 % of the contralateral side. Radiological evaluation demonstrated a correction of the static instability in nine cases. In two patients recurrence of static instability was obvious. The prerequisite for success of the procedure is the easy reduction of the carpals. In cases of a fixed rotatory subluxation of the scaphoid, the technique cannot maintain the reduction.
Lutz
M
M
Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Innsbruck, Osterreich. martin.lutz@uklibk.ac.at
Haid
C
C
Goebel
G
G
Gabl
M
M
Pechlaner
S
S
D000328:Adult; D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000637:transplantation; D011859:Radiography; D021361:Scaphoid Bone / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*