[Dorsal capsulodesis for the treatment of scapholunate instability].
OBJECTIVE
To regain stability of the proximal carpal row after scapholunate ligament rupture in order to avoid osteoarthritis and carpal collapse.


METHODS
As additional therapy in scapholunate ligament repair especially in patients with static, but reducible scapholunate malalignment.


METHODS
Fixed scapholunate malalignment. Osteoarthritis of the radiocarpal or the midcarpal joint.


METHODS
Dorsal approach to the carpal joint with release of the second, third and fourth extensor compartment and resection of the dorsal interosseous nerve. Opening of the radiocarpal joint for inspection of the chondral surfaces and the scapholunate ligament for possible repair. If needed, reduction of scaphoid and lunate. Repair of the scapholunate ligament. If a reduction of scaphoid and lunate is necessary, temporary Kirschner wire fixation of the scaphoid to the capitate and the lunate. The dorsal intercarpal ligament is identified and its middle third is dissected and elevated from the triquetrum remaining attached to the distal scaphoid pole. The ulnar end of the elevated part of the dorsal intercarpal ligament is pulled through a split in the dorsal radiotriquetral ligament and fixed to itself. Closure of the proximal and distal third of the dorsal intercarpal ligament.


METHODS
Management Immobilization in a below-elbow cast including the metacarpophalangeal joint of the thumb for 6 weeks. Removal of the Kirschner wires, if used, 8 weeks postoperatively. Physiotherapy to improve wrist motion.


RESULTS
Most of the reports in the literature show an improvement of pain. The effect on radiologic parameters and the development of osteoarthritis remains uncertain.
Stephan
Christine
C
Klinik für Handchirurgie, Bad Neustadt an der Saale, Germany. c.stephan@handchirurgie.de
Prommersberger
Karl-Josef
KJ
van Schoonhoven
Jörg
J
D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008022:Ligaments / Q000293:injuries* / Q000601:surgery*; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D012540:Scapula / Q000601:surgery*; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery