title: Soft tissue stabilization for palmar midcarpal instability using a palmaris longus tendon graft.
abstract: OBJECTIVE
  To report the results of a technique of soft tissue stabilization for palmar midcarpal instability using a palmaris longus graft.
  
  
  METHODS
  In patients' symptomatic wrists with palmar midcarpal instability that had failed conservative management, we used a dorsal approach and stabilized the hamate and triquetrum by reconstructing the dorsal triquetrohamate ligament. The palmaris longus tendon graft was fixed with bone anchors. Seven wrists in 6 patients were available for follow-up at a mean of 28 months (range, 17-37 mo).
  
  
  RESULTS
  There was an overall meaningful improvement in function (mean preoperative Disabilities of the Arm, Shoulder, and Hand score, 49 preoperatively, 28 postoperatively). There was a significant increase in grip strength from 15 to 21 kg. At final follow-up, 2 patients had moderate pain. The others had mild or no pain. Four patients returned to their previous occupation or activity. Patients retained full pronation and supination. When compared with the normal side, flexion was reduced to 71%, extension to 81%, radial deviation to 90%, and ulnar deviation to 65% of the opposite side. Although the mean results show an improvement, one patient had a poor result with deterioration in Disabilities of the Arm, Shoulder, and Hand score in spite of a clinically stable wrist, and another had clinical evidence of recurrent instability during pregnancy. One patient had residual symptoms from a prominent bone anchor.
  
  
  CONCLUSIONS
  Overall, this technique showed good medium-term results in most of our patients. It retained some midcarpal mobility, eliminated clunking in most patients, and provided a noteworthy improvement in grip strength and function. We continue to use this technique for patients with symptomatic midcarpal instability, but it requires further evaluation with larger patient numbers and a longer follow-up to assess its overall value.
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road, Birmingham, UK. Electronic address: Tahseen_c@hotmail.com.
authors.forename: Tahseen
authors.initials: T
authors.lastname: Chaudhry
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road, Birmingham, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shahid
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road, Birmingham, UK.
authors.forename: Feiran
authors.initials: F
authors.lastname: Wu
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road, Birmingham, UK.
authors.forename: Anuj
authors.initials: A
authors.lastname: Mishra
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road, Birmingham, UK.
authors.forename: Subodh
authors.initials: S
authors.lastname: Deshmukh
mesh_terms: D000328:Adult; D050824:Carpal Joints / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D051225:Hamate Bone; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery; D008297:Male; D011859:Radiography; D020127:Recovery of Function; D053441:Suture Anchors; D013710:Tendons / Q000637:transplantation*; D051221:Triquetrum Bone; D055815:Young Adult
keywords: Nondissociative; instability; midcarpal; palmar; stabilization