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CC BY-NC-ND 4.0 · J Wrist Surg 2023; 12(01): 073-080
DOI: 10.1055/s-0041-1735304
Procedure

Dynadesis for Treatment of Dynamic Scaphoid Instability with 20-Year Results

Houshang Seradge 
1   Seradge Medical, Oklahoma City, Oklahoma
,
Winfred Parker
1   Seradge Medical, Oklahoma City, Oklahoma
,
Carrie Seradge 
1   Seradge Medical, Oklahoma City, Oklahoma
,
Cyrus Steppe 
1   Seradge Medical, Oklahoma City, Oklahoma
,
Ashley McKenzie
1   Seradge Medical, Oklahoma City, Oklahoma
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Abstract

Background Even though the scapholunate interosseous ligament is the most common wrist ligament injury, its treatment remains a challenge for hand surgeons. We report on a surgical treatment (Dynadesis) for dynamic scaphoid instability (DSI) with a 20-year follow-up period.

Description of Technique Dynadesis utilizes antagonist forearm muscles in order to synergistically provide dynamic stabilization to the scaphoid when the wrist is loaded. It is a tendon-to-tendon transfer with the following two components: 1) Dorsal—The extensor carpi radialis longus (ECRL) is passed through a hole in the reduced, distal scaphoid, providing the scaphoid with an independent extension force. 2) Volar—A dynamic checkrein is created by tension-locking the ECRL tendon around the flexor carpi radialis (FCR) tendon. The portion of the FCR distal to the scaphoid tethers and tightens with contracture of the ECRL and FCR muscles.

Patients and Methods Twenty patients (21 wrists) were treated with Dynadesis and reevaluated 20 years later (range: 20–27 years).

Results Average grip strength improved by 8 kg. The average wrist flexion-extension arc decreased by 3°. Wrist X-rays showed no radiocarpal arthritis. On the Mayo wrist score, 81% reported excellent to good results (average: 89). Pain levels improved by 90%, with 76% of patients reporting no pain. All patients (100%) were satisfied with their results and would recommend the procedure.

Conclusions Dynadesis is specifically designed for the treatment of DSI. It avoids the eventual complication of osteoarthritis and does not sacrifice wrist motion. A predictable and satisfactory long-term result is obtainable with correct patient selection based on clinical staging and arthroscopic findings.

Keywords

carpal instability - long term results - scapholunate ligament - tenodesis - wrist instability - scaphoid - dynamic scaphoid instability


Publication History

Received: 13 May 2021

Accepted: 27 July 2021

Article published online:
28 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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