Current innovations in wrist arthroscopy.
It has become clear that the stability of the scapholunate joint does not depend wholly on the scapholunate interosseous ligament, but rather on both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and should be treated with tissue-specific repairs, which may partly explain why one procedure cannot successfully restore joint stability in every case. Wrist arthroscopy has a pivotal role in both the assessment and treatment of the scapholunate ligament complex derangements. Tears of the foveal attachment of the triangular fibrocartilaginous complex can be an underdiagnosed cause of distal radioulnar joint instability, because the foveal fibers cannot be visualized using the standard radiocarpal arthroscopy portals. Distal radioulnar joint arthroscopy allows for direct visualization and assessment of these fibers, which in turn has spawned a number of open and arthroscopic repair methods. Wrist arthroscopy has gained wider acceptance as a method to fine-tune articular reduction during open and percutaneous fixation of distal radius fractures, and simplifies intra-articular osteotomies for malunion. It can facilitate percutaneous bone grafting of scaphoid nonunions and has a role in the diagnosis and treatment of associated soft tissue lesions. These and other recent developments will be discussed in the following article.
Hand and Wrist Institute, Torrance, CA 90503, USA. d-slutsky@msn.com
David J
DJ
Slutsky
D000768:Anesthesia, General; D001170:Arthritis, Infectious / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D001863:Bone Screws; D002348:Carpal Bones / Q000293:injuries*; D003646:Debridement / Q000379:methods; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D012667:Lunate Bone / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011885:Radius Fractures / Q000601:surgery; D012086:Reoperation; D021361:Scaphoid Bone / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome; D051478:Triangular Fibrocartilage / Q000293:injuries / Q000601:surgery; D014955:Wrist Joint / Q000601:surgery*