Treatment Of Scapholunate Dissociation Research Articles

Scaphoid excision and four corner fusion in treatment of scapholunate dissociation

The purpose of this study was to evaluate the clinical outcome, union rate, and complications of a consecutive series of scaphoid excision and four-corner arthrodeses performed by a three surgeon using distal radius bone graft Herbert screws or K-wires or cannulated Synthes screws or Flower plate fixation. Mean duration of follow-up was 16 months. The results of the present study revealed that, patient satisfaction is high, and the procedure offers well to excellent pain relief. Advances in surgical exposures, fixation techniques, and implants have allowed for rigid fixation that enables for rapid union and the commencement of early range of motion. Failure rates and complication rates are relatively low, and long-term outcomes have been promising

Extensor Carpi Radialis Longus Tenodesis Using a Biotenodesis Screw for Treatment of Symptomatic Geissler 2 Scapholunate Dissociation

Treatment of scapholunate dissociation (SLD) depends on the degree of injury. We present our technique of extensor carpi radialis longus (ECRL) tenodesis for Geissler grade 2 SLD and our preliminary results. After arthroscopic confirmation of Geissler grade 2 SLD, we use a single incision and a polyetheretherketone (PEEK) anchor, attaching half of the ECRL tendon to the scaphoid. Preliminary results include improvements in QDASH, QDASH (work) and QDASH (sports/music), a median satisfaction level of 4/5 (satisfied), and a low complication rate. Our method is a safe, reproducible, and effective treatment of symptomatic Geissler grade 2 SLD that has failed nonoperative management, with technical advantages over alternative methods in the literature.

Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft

ObjectivesTo measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. MethodsFrom January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. ResultsThe follow-up time was 12 months (3–17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1–6). DASH was 6.50/100 (1–30). The time to work return work was 4.42 months (2–17). As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities.The preoperative SL gap was 4.29mm (2–7); in the postoperative period, it was 1.79mm (1–4). The DISI deformity was present in ten patients with SL angle>70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. ConclusionThe new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

Capsulodese dorsal associada à reconstrução assistida por artroscopia do ligamento escafossemilunar com enxerto do tendão do músculo palmar longo

ObjectivesTo measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. MethodsFrom January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analogue scale (VAS), and radiographic analysis to visualize the pre‐ and postoperative SL gap and the pre‐ and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. ResultsThe follow‐up time was 12 months (3–17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1–6). DASH was 6.50/100 (1–30). The time to work return work was 4.42 months (2–17). As for complications, one patient developed SLAC, and underwent four‐corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities.The preoperative SL gap was 4.29mm (2–7); in the postoperative period, it was 1.79mm (1–4). The DISI deformity was present in ten patients with SL angle>70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. ConclusionThe new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients.

The purpose of this retrospective study was to assess the modified Brunelli technique for the treatment of chronic irreparable complete scapholunate ligament rupture, causing a reducible carpal malalignment without secondary osteoarthritis. A total of 20 patients were treated using this technique. At a mean follow-up period of 24 months (range 6-53, SD 15), pain on a visual analogue scale had improved from 6 (range 3-10) to 3 (range 0-7). Function measured with the DASH score had improved from 37 (range 11-90) to 20 (range 0-53). Range of motion was reduced in flexion by a mean of 19° (range 10-45), and in extension by a mean of 14° (range 0-35). Mean grip strength at last follow-up was 81% of the uninjured hand (range 50-100%) Three patients developed scapholunate advanced collapse (stage II) requiring salvage surgery. Scapholunate ligament reconstruction with the modified Brunelli technique showed satisfactory results in this study. Extended studies are needed to determine the long-term benefits of this reconstructive procedure. IV.

Preliminary results with Cuénod's osteoligamentoplasty and capsulodesis for treatment of chronic scapholunate dissociation

Until now, the ideal treatment of scapholunate dissociation has not yet been found. Cuénod described an operation with reconstruction of the dorsal part of the scapholunate ligament using a bone-ligament-bone autograft (dorsal trapezoidometacarpal II ligament) and an additional dorsal capsulodesis using the dorsal intercarpal ligament. From December 2000 until January 2002, we operated on twelve patients with symptomatic chronic scapholunate dissociation without signs of osteoarthrosis using Cuénod's procedure. Preoperatively as well as at follow-up patients were evaluated using a traditional wrist score and a DASH-questionnaire in addition to clinical examination. X-rays of both wrists in two planes each and additional stress radiographs were done. All patients had an arthroscopy preoperatively and a CT scan before K-wire removal. The mean follow-up time was twelve months. Clinical follow-up showed good results (traditional wrist score: 77 points; DASH-score: 27 points), but with regard to the good preoperative findings (traditional wrist score: 73 points; DASH-score: 28 points) no significant improvement. Postoperative X-rays showed a correction of static instability in three cases; in four cases we found a recurrent SL gap, which was interpreted as failure of the transplanted ligament. Until now, one patient had to be reoperated by STT-fusion. In our patients, Cuénod's operation showed different results. So, further studies are necessary to find the correct indications for applying this procedure.

Treatment of scapholunate dissociation: ligamentous repair associated with modified dorsal capsulodesis.

We previously reported that our repair and/or reconstruction of the scapholunate interosseous ligament reduced the scapholunate dissociation and improved the clinical results. Re-evaluation of these patients after three years revealed that malrotation of the scaphoid advanced significantly although the clinical results declined only slightly. To prevent progression of scaphoid malrotation, a modified dorsal capsulodesis was subsequently added to the ligamentous repair of scapholunate dissociation. The records of 17 patients were available for this study. The time lapse from injury to surgical treatment ranged from four days to one year and six months. All but three patients were operated less than two months after the injury. All patients were followed for more than one year, with an average of 49 months. Clinical results were expressed by a modification of the point score method of Green and O'Brien. Scapholunate angles were measured on lateral X-ray films with the wrist in neutral position. Overall clinical results averaged 83 points (range: 25-100). The scapholunate angles averaged 49 degrees (range: 45-60). In the three patients, in whom the operation was performed more than 11 months after the injury, the clinical results averaged 38 points and scapholunate angles averaged 54 degrees, respectively. These clinical and X-ray results suggest that early repair of the scapholunate interosseous ligament along with a modified dorsal capsulodesis is a useful procedure in the treatment of scapholunate dissociation.

Treatment of scapholunate dissociation by ligamentous repair and capsulodesis

We believe that direct scapholunate ligamentous repair, supported by a dorsal radioscaphoid capsulodesis, should be considered for the treatment of most scapholunate dissociations when there is no osteoarthritis, regardless of the time that has elapsed since injury. We treated 24 patients by this technique between 1972 and 1988. The records of 21 were available for study. Average time from injury to surgical treatment was 17 months (range, 1 to 84 months). Results were evaluated clinically and by means of patient questionnaire and x-ray films. The significant change in range of motion was a loss of palmar flexion, which averaged 11.5 degrees. Grip strength, pain, and x-ray appearance improved in all cases. Only one patient had to change occupations after surgery because of wrist symptoms. Three had minimal x-ray degenerative changes, which did not result in increased pain or in loss of motion and grip strength. There were no complications.

The role of arthroscopy in the treatment of scapholunate dissociation

The role of arthroscopy in the treatment of scapholunate dissociation