Download PDF
J Wrist Surg 2020; 09(01): 076-080
DOI: 10.1055/s-0039-3401014
Wrist and Carpal Anatomy
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Scapholunate Ligament Injury and the Effect of Scaphoid Lengthening

Matthew J. Furey
1   Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2   Western Upper Limb Facility, Sturgeon Hospital, Edmonton, Alberta, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
,
Neil J. White
1   Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Gurpreet S. Dhaliwal
1   Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
› Author Affiliations Funding The study was funded by the University of Calgary Hand and Wrist Fellowship Fund.
Further Information

Publication History

30 July 2019

01 November 2019

Publication Date:
20 December 2019 (online)

    Permissions and Reprints

Abstract

Objective We hypothesized that lengthening the scaphoid in a model of scapholunate ligament injury (SLI) will result in correction of radiographic markers of dorsal intercalated segment instability (DISI) deformity.

Materials and Methods An SLI with DISI deformity was created by sectioning the SL ligament, the palmar radiocarpal ligaments, and scapho-trapezio-trapezoid ligaments of a cadaveric upper extremity (n = 5). The wrist was radiographed in both anteroposterior and lateral planes to confirm creation of SLI and DISI. The scaphoid was then osteotomized at its waist. A series of grafts (1–8 mm) were then placed at the osteotomy site. Radiographs were completed at each length. The main outcome measures were scapholunate interval (SL, mm), scapholunate angle (SLA, degrees), and radiolunate angle (RLA, degrees). These values, measured following the insertion of varying graft lengths, were compared with baseline measurements taken “post-injury” status.

Results The ability to create an SLI with DISI was confirmed in the postinjury group with a statistically significant change in RLA, SLA, and SL compared with preinjury. With osteotomy and progressive insertion of spacers, the values improved into the accepted normal ranges for RLA (6 mm) and SLA (4 mm) with scaphoid lengthening.

Conclusions In this cadaveric model of SL injury, radiographic markers of DISI were returned to within normal ranges with scaphoid osteotomy and lengthening.

Clinical Relevance The results of this study add insight into wrist kinematics in our injury model and may represent a potential future direction for surgical treatment of SLI.

Keywords

scapholunate - scaphoid - DISI
 

  • References

  • 1 Garcia-Elias M. Carpal instability. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH. , eds. Green's Operative Hand Surgery, 6th edition. Philadelphia: Churchill Livingstone; 2011. : Chap 15
    Google Scholar
  • 2 Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin 1997; 13 (01) 39-49
    CrossrefPubMedGoogle Scholar
  • 3 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 4 Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin 1987; 3 (01) 81-102
    PubMedGoogle Scholar
  • 5 Van Den Abbeele KL, Loh YC, Stanley JK, Trail IA. Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg [Br] 1998; 23 (02) 258-261
    CrossrefPubMedGoogle Scholar
  • 6 Rosenwasser MP, Miyasajsa KC, Strauch RJ. The RASL procedure: reduction and association of the scaphoid and lunate using the Herbert screw. Tech Hand Up Extrem Surg 1997; 1 (04) 263-272
    CrossrefPubMedGoogle Scholar
  • 7 Adams JE, Steinmann SP. Acute scaphoid fractures. Orthop Clin North Am 2007; 38 (02) 229-235 , vi
    CrossrefPubMedGoogle Scholar
  • 8 Higgins JP, Burger HK. Proximal scaphoid arthroplasty using the medial femoral trochlea flap. J Wrist Surg 2013; 2 (03) 228-233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Elgammal A, Lukas B. Vascularized medial femoral condyle graft for management of scaphoid non-union. J Hand Surg Eur Vol 2015; 40 (08) 848-854
    CrossrefPubMedGoogle Scholar
  • 10 Capito AE, Higgins JP. Scaphoid overstuffing: the effects of the dimensions of scaphoid reconstruction on scapholunate alignment. J Hand Surg Am 2013; 38 (12) 2419-2425
    CrossrefPubMedGoogle Scholar
  • 11 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am 2005; 30 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 12 Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N. Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg Am 2011; 36 (07) 1149-1157
    CrossrefPubMedGoogle Scholar
  • 13 Holm S. A simple sequential rejective multiple test procedure. Scand J Stat 1979; 6: 65-70
    PubMedGoogle Scholar
  • 14 Larson TB, Stern PJ. Reduction and association of the scaphoid and lunate procedure: short-term clinical and radiographic outcomes. J Hand Surg Am 2014; 39 (11) 2168-2174
    CrossrefPubMedGoogle Scholar
  • 15 Elgammal A, Lukas B. Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients. J Hand Surg Eur Vol 2016; 41 (01) 56-63
    CrossrefPubMedGoogle Scholar
  • 16 Johnston HM. Varying positions of the carpal bones in the different movements at the wrist: part I. J Anat Physiol 1907; 41 (Pt 2): 109-122
    PubMedGoogle Scholar
  • 17 Taleisnik J. Wrist Anatomy, Function, and Injury. AAOS Instr. Course Lect. St. Louis: Mosby; 1978: 61-87
    Google Scholar
  • 18 Lichtman DM, Bruckner JD, Culp RW, Alexander CE. Palmar midcarpal instability: results of surgical reconstruction. J Hand Surg Am 1993; 18 (02) 307-315
    CrossrefPubMedGoogle Scholar
  • 19 Garcia-Elias M. Understanding wrist mechanics: a long and winding road. J Wrist Surg 2013; 2 (01) 5-12
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Dunn MJ, Johnson C. Static scapholunate dissociation: a new reconstruction technique using a volar and dorsal approach in a cadaver model. J Hand Surg Am 2001; 26 (04) 749-754
    CrossrefPubMedGoogle Scholar
  • 21 Pollock PJ, Sieg RN, Baechler MF, Scher D, Zimmerman NB, Dubin NH. Radiographic evaluation of the modified Brunelli technique versus the Blatt capsulodesis for scapholunate dissociation in a cadaver model. J Hand Surg Am 2010; 35 (10) 1589-1598
    CrossrefPubMedGoogle Scholar
  • 22 Slater Jr RR, Szabo RM, Bay BK, Laubach J. Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model. J Hand Surg Am 1999; 24 (02) 232-239
    CrossrefPubMedGoogle Scholar