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J Wrist Surg
DOI: 10.1055/a-2698-9457
Procedure

A Novel Technique in Treatment of Midcarpal Instability: Hammock Technique

İsmail B. Özçelik 
1   El İstanbul Hand and Upper Extremity Group, Nişantaşı University Health Science Faculty, Yeni Yüzyıl University Gaziosmanpaşa Hospital Hand and Upper Extremity Surgery, İstanbul Yeni Yüzyıl University, Merkez- Gaziosmanpaşa/İstanbul, Türkiye
,
Haitham S. Elawadlly 
2   Orthopedics and Trauma Surgery Deparment, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
,
Uğur Kayık 
3   Department of Orthopaedics and Traumatology, Erzurum City Hospital, Yakutiye/Erzurum, Türkiye
,
Yücel Ağırdıl 
4   El İstanbul Hand and Upper Extremity Group, Nişantaşı University Vocational High Scholl, Yeni Yüzyıl University Gaziosmanpaşa Hospital Hand and Upper Extremity Surgery, İstanbul Yeni Yüzyıl University, Merkez- Gaziosmanpaşa/İstanbul, Türkiye
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Funding Information None.
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Abstract

Background

Midcarpal instability (MCI) is a relatively uncommon yet disabling condition that manifests with wrist pain, weakness, and diminished grip strength. Diagnosis is primarily clinical, supported by dynamic imaging modalities such as video fluoroscopy and 4D CT. Initial management typically involves non-operative measures including patient education, activity modification, pain control, dynamic splinting, hand therapy, and proprioceptive training. Surgical intervention is considered in cases refractory to conservative treatment.

Objectives

To describe our novel “Hammock Technique” as a surgical method for the management of midcarpal instability (MCI). We outlines the detailed surgical steps of the procedure, defines its indications, and presents the standardized postoperative rehabilitation protocol. Furthermore, we highlight potential complications and discuss the technique’s role within the current spectrum of treatment options for MCI.

Materials and Methods

The Hammock Technique was developed to address ligament dysfunction and hyperlaxity in both the dorsal and palmar regions of the wrist, as well as around the scaphoid. This technique employs the palmaris longus tendon, incorporated with the wrist capsule, to achieve a “triple effect”: (1) reinforcement of the dorsal ligaments, (2) hammock-like support for the proximal capitate and (3) stabilization of the scaphoid through fixation of its distal pole. It is particularly indicated for mild to moderate cases of midcarpal instability and can be effectively applied to both palmar and dorsal subtypes.

Results

Application of the Hammock Technique demonstrated improved midcarpal stability, restoration of functional wrist motion, and enhanced grip strength in patients with mild to moderate MCI. Early outcomes suggest reproducibility and safety, with a low complication rate.

Conclusion

The Hammock Technique represents a simple, biologically sound, and effective surgical option for the treatment of mild to moderate MCI. It can be applied to both palmar and dorsal subtypes, offering satisfactory stability and functional outcomes while preserving native wrist kinematics.

Keywords

midcarpal instability - intrinsic - extrinsic - proprioception - videofluoroscopy - hammock technique - palmaris longus

Ethical Approval

This study was conducted in accordance with principles of the Declaration of Helsinki and its subsequent amendments. The research protocol was approved by the Atatürk University Faculty of Medicine Clinical Research Ethics Committee (IRB number: B.30.2.ATA.0.01.00/93). Written informed consent was obtained from all applicable patients.




Publication History

Received: 08 June 2025

Accepted: 01 September 2025

Article published online:
23 September 2025

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