Novel Treatment of a Scapholunate Ligament Injury with Proximal Pole Scaphoid Nonunion.
BACKGROUND
Nonunion of scaphoid proximal pole fractures presents a challenging management dilemma to hand surgeons. This problem is further complicated in the uncommon concurrence of scapholunate (SL) ligament disruption.


METHODS
A 39-year-old male patient presented with new-onset wrist pain following a remote history of a proximal pole scaphoid fracture sustained as a teenager, which was treated nonoperatively. Six months before presentation, the patient sustained a fall while snowboarding. The patient was found to have a chronic nonunion of his scaphoid proximal pole with an associated SL ligament disruption. As the proximal fragment was too small to be amenable to fixation, the patient was treated with an arthroscopic partial scaphoid excision and SL ligament reconstruction using a scapholunateintercarpal screw placed percutaneously. At 26 months, the patient exhibited no pain, near-normal strength, and wrist motion, and expressed a high-level of satisfaction from his surgery.


METHODS
Although cases of SL ligament disruption with concomitant proximal scaphoid fractures have been reported, to our knowledge, this is the first report of SL ligament rupture occurring in the setting of a preexisting proximal pole scaphoid nonunion.


CONCLUSIONS
We report the use of SL ligament reconstruction augmented with intercarpal screw fixation, and excision of the proximal pole scaphoid nonunion. This minimallyinvasive approach may be a particularly useful option in young, active patients such as our own, where a motion-sacrificing salvage procedure would be less than ideal.
Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.
Michael P
MP
Gaspar
Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.
Patrick M
PM
Kane
Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.
Sidney M
SM
Jacoby
Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.
Randall W
RW
Culp
SLIC; intercarpal screw; proximal pole; scaphoid fracture nonunion; scapholunate ligament injury