Abstract
Complete rupture of the scapholunate (SL) ligament can cause adissociative carpal instability (CID). These ligamentous lesions are caused by afall from alimited height of approximately 1 m or afall, e. g. when playing handball or soccer. For afreshly injured wrist joint, the X‑ray signs of astatic instability (after excluding afracture) are aSL distance ≥3 mm, aSL angle >60°, and adorsal displacement of the proximal scaphoid pole. Dynamic instabilities are best seen in kinematography of the wrist joint. Early ligament refixation is mandatory, ideally done in the first week after the incident or at least within the first 3 weeks. The cornerstone of the procedure is an anatomic reduction of the SL joint stabilized with K‑wires for 8weeks. In older lesions, ligament transfer or ligamentoplasty using atendon transfer may add to stability but have so far not achieved areliable joint alignment despite usually good functional results. It appears that the reduction of the proximal scaphoid pole deserves more attention.
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