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PubMed2003

The natural history of an untreated isolated scapholunate interosseus ligament injury.

The natural history of an untreated isolated scapholunate interosseus ligament injury remains unclear, although it is commonly assumed that patients continue to suffer with pain, stiffness and weakness of the wrist and ultimately develop secondary osteoarthritis (SLAC wrist). In this study, we evaluated the clinical condition of 11 patients with an arthroscopically proven interosseus scapholunate ligament injury, but without any radiological signs of either DISI deformity or scapholunate gapping, who had declined further treatment at an average follow-up of 7 years. Whilst there was on going pain and functional limitation in all cases, there was no rapid progression to degenerative change (SLAC wrist).

Activities of Daily Living↗
PubMedDate not supplied

Normal ranges of scapholunate distance in children 6 to 14 years old.

SUMMARY: The purpose of this study was to determine the normal ranges of scapholunate distance (SLD) applicable to children. Bone age radiographs of 85 children (36 boys, 49 girls) 6 to 14 years of age were used to establish the normal ranges. Repeated-measures analysis of variance revealed significant age and gender differences. Therefore, linear regression was used to determine normal SLD ranges separately for girls and boys based on chronologic age and bone age. SLD normal ranges were similar for chronologic age and bone age. Interobserver and intraobserver agreement was excellent. There was no significant age by gender interaction found, indicating that although boys had significantly longer distances than girls, both showed a similar rate of decreasing SLD distance with age. These results provide age-and gender-based normal ranges of SLD in young children. These results may be useful in assessing traumatic soft tissue injuries about the pediatric wrist. Of note, only three girls and two boys (all 12 years or older) met the adult criterion of normal SLD of < or = 2 mm.

Adolescent↗
PubMed2004

[The measurement of wrist kinematics in children 4 to 16 years old and the comparison of the scapholunate distance with adult values].

OBJECTIVES: We sought to determine the position and values of the kinematic indices of the wrist (center of rotation, carpal height, carpal-ulnar distance), the third metacarpal length, and the scapholunate distance for children and compared the results with those reported for adults. METHODS: The study included 41 children (24 girls, 17 boys; age range 4 to 16 years) who presented with wrist and/or forearm injuries, and whose radiographs of the other wrist had been obtained for comparison. The children were divided into six age groups separated by 2-year intervals regardless of gender or the side of the wrists involved. Measurements were made on standard posteroanterior radiographs of healthy wrists and the mean values obtained were statistically analyzed. RESULTS: The carpal height, carpal-ulnar distance and the third metacarpal length were significantly different in all age groups. The ratios of the carpal height and the carpal-ulnar distance to the third metacarpal length were similar both in the age groups and to those reported for the adult values. However, the scapholunate distance exhibited significant differences between the age groups and from the standard adult value. CONCLUSION: The adult values given for the ratios of the carpal height and the carpal-ulnar distance to the third metacarpal length can be adopted as standard values for children. However, determination of the scapholunate dissociation in children should not be based on the normal range given for adults.

Adolescent↗
PubMed2003

[Diagnostics at the wrist].

Injuries of the wrist are difficult to diagnose because of the complex and narrow anatomic structures. Based on precise clinical examination, X-rays, CT, and MRI are valuable additional tools that can be used. If a fracture is suspected a CT scan is preferable. In the case of a suspected soft tissue or ligamentous injury and non-vital fragments or necrosis MRI is suitable. Other diagnostic tools are presently of minor importance for the wrist. Technical innovations allow better visualization and classification of lesions. However, exact knowledge of the tools is important.

Adult↗
PubMed2001

Periscapho-lunate dislocation.

A case of a volar periscapholunate dislocation is reported. Treatment by closed reduction and Kirschner wire fixation gave a good clinical result.

Accidental Falls↗
PubMed2005

Incomplete scapholunate and trapeziotrapezoid coalitions with an accessory carpal bone.

Coalitions of the carpal bones associated with accessory carpal bones are relatively uncommon. We present a case of scapholunate and trapeziotrapezoid incomplete coalition with a dorsally situated accessory bone between trapezium and trapezoideum. X-ray, computed tomography, and magnetic resonance imaging findings of the patient are discussed in light of the pertinent literature.

Adult↗
PubMed2002

Traumatic axial dislocation of the carpus: a case report of transscaphoid pericapitate transhamate axial dislocation.

Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. The disruption pattern was different from those of previously reported cases. Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion (ROM) exercise are the treatment of choice in such complex injuries.

Adult↗
PubMed2006

Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability.

PURPOSE: The ideal treatment for scapholunate (SL) instability has not yet been established. This study examined the results of 2 procedures for the primary treatment for chronic SL dissociation of dorsal capsulodesis and flexor carpi radialis tenodesis. METHODS: A retrospective analysis was conducted that examined dorsal capsulodesis and tenodesis procedures performed for chronic SL instability between January 1995 and February of 2003. Twenty-nine patients were identified with isolated chronic SL instability. Of the 29 patients, 14 had a dorsal capsulodesis procedure and 15 had a tenodesis procedure. The follow-up period averaged 38 months in the capsulodesis group and 36 months in the tenodesis group. Results were reviewed clinically and radiographically. Groups were compared with a Student t test. RESULTS: Postoperative wrist motion decreased in both groups after surgery. Final wrist range of motion was 64% of the unaffected side in the capsulodesis group and 63% of the unaffected side in the tenodesis group. Postoperative grip strength remained unchanged in both groups; grip strength measured 91% of the unaffected side in the capsulodesis group and 87% of the unaffected side in the tenodesis group. The average Mayo wrist scores were 77 in the capsulodesis group and 74 in the tenodesis group. One frank failure occurred in the tenodesis group resulting in a wrist fusion. There was no statistical difference in the overall wrist motion, grip strength, or wrist scores between the capsulodesis and tenodesis groups. CONCLUSIONS: Dorsal capsulodesis and tenodesis provided improvement in symptoms for patients with chronic SL instability. Both procedures appear to provide similar results in the treatment of this difficult problem.

Adult↗
PubMed2001

[Atypical Fenton syndrome].

The case of a patient 41 years old is reported. He sustained a posterior open carpal fracture dislocation transcapho-trans-capitate with radius styloid process fracture. The original aspect of this observation is that the lunatum was enucleated. The treatment was not usual. Capitatum bone was first fixed and associated with an external fixation. Proximal row carpectomy was performed in a second procedure when removing internal and external fixation, capitatum being healed. Follow up is now at four years with a very good radiological and clinical result. The patient is working with an intermittent mild pain. Radiographic examination demonstrated a very good vascularisation of the capitate head.

Adult↗
PubMed2001

Isolated scaphotrapeziotrapezoid osteoarthritis: prevalence, symptomatology and associated scapholunate ligament disruption in a population presenting to an accident and emergency department with acute wrist injuries.

AIM: To determine the prevalence of isolated scaphotrapeziotrapezoid osteoarthritis in a population presenting to an Accident and Emergency Department of Leicester Royal Infirmary with acute wrist injuries. Also to identify the presence of scapholunate ligament disruption in this patient group and quantify symptoms and loss of function in terms of the modified system of Green and O'Brien, a recognized clinical scoring system. MATERIALS AND METHODS: A total of 1711 radiographs of patients attending the Accident and Emergency Department were prospectively reviewed over a 5-month period. Those patients with isolated scaphotrapeziotrapezoid osteoarthritis were invited for clinical review. RESULTS: Sixteen patients were identified with isolated scaphotrapeziotrapezoid osteoarthritis. Two had a poor Green and O'Brien score and evidence of scapholunate ligament disruption (P < 0.05). CONCLUSION: Isolated scaphotrapeziotrapezoid osteoarthritis has a prevalence of 1% in a population presenting to an Accident and Emergency Department with acute wrist injuries over the age of 30 years. Isolated scaphotrapeziotrapezoid osteoarthritis may be asymptomatic even though the changes in the joint are severe. Scapholunate ligament disruption is associated with a poor Green and O'Brien score, but is not present in the majority of cases. Higginson, A. P.et al. (2001). Clinical Radiology56, 372-374.

Acute Disease↗
PubMed2001

Static scapholunate dissociation: a new reconstruction technique using a volar and dorsal approach in a cadaver model.

We used 4 fresh-frozen cadaver arms to assess a method of reconstruction we designed for static scapholunate dissociation. The dorsal scapholunate ligament, scapholunate interosseous ligament, radioscapholunate, and radioscaphocapitate ligaments were sectioned. Radiographs were taken before sectioning, after sectioning, and after reconstruction. Passive motion was also measured before sectioning and after the repair. The dorsal scapholunate ligament was repaired directly; the palmar radioscapholunate and radioscaphocapitate ligaments were reconstructed using a free flexor carpi radialis tendon autograft and Mitek mini suture anchors (1.8-mm diameter and 5.4-mm length; Mitek Products, Norwood, MA) for anatomic fixation. An independent board-certified hand surgeon analyzed the radiographs of the wrists taken before and after sectioning and after reconstruction. Assessment of the unsectioned wrists revealed an average scapholunate angle of 45 degrees. After scapholunate dissociation was created the average scapholunate angle was 71 degrees. Repair of the dorsal scapholunate ligament alone did not improve the scapholunate angle. Average scapholunate angle after repair of the dorsal scapholunate ligament and reconstruction of the palmar ligaments was 43 degrees. Average range of motion on flexion, extension, and radial and ulnar deviation before ligament sectioning and after reconstruction was unchanged at 54 degrees, 59 degrees, 19 degrees, and 40 degrees respectively. This technique shows an improvement in scapholunate angle on lateral radiographs, and passive motion remained relatively unchanged.

Cadaver↗
PubMed2001

[Experiences with the STT (scapho-trapezio-trapezoid) arthrodesis. A retrospective evaluation].

From 1992 until 1998, 98 fusions of the scapho-trapezio-trapezoid joint on 97 patients were performed in our clinic. The indications were dissociation of the scapho-lunate joint (n = 32), necrosis of the lunate stage III/IV (Lichtman classification) (n = 39), and idiopathic arthrosis of the scapho-trapezio-trapezoid joint (n = 27). 87 patients with 88 procedures were reviewed after an average follow-up period of three years. The review included a clinical examination with determination of a traditional wrist-score and a DASH questionnaire, X-rays of the wrist and CT of the carpal bones. The results in the wristscore were on average 74 of maximal 100 points. The DASH-score was on average 29. The best results were in the group with arthrosis of the scapho-trapezio-trapezoid joint. The results in the groups with scapho-lunate dissociation and necrosis of the lunate were also good. The rate of non-union was within an acceptable level with 7.7%. In the examined group, five patients underwent fusion of the wrist for persisting pain after scapho-trapezio-trapezoid arthrodesis. The examination of the radiological investigations in the reviewed group demonstrated, that CT shows arthritic degeneration in patients where the conventional X-ray does not. In conclusion, scapho-trapezio-trapezoid arthrodesis is a valid therapeutic method in the above mentioned indications. However, the question how early arthritic degeneration will affect long-term results remains unanswered for the moment.

Adolescent↗
PubMed2001

[Dorsal V-ligament reconstruction in scapholunate instability].

In dynamic and static scapholunate instability after trauma, the repair of the scapholunate ligament is important to avoid scapholunate advanced collapse of the wrist. Direct suture even of fresh-torn ligaments can be technically demanding and occasionally unreliable, thus reconstruction may require additional tissue beside the ligament. Eighteen patients suffering from dynamic (n = 10) and static (n = 8) scapholunate instability were treated by a dorsal ligament reconstruction six months after trauma. A clinical wrist score according to Cooney showed an average of 86 points (maximum 100) within a follow-up of nineteen months after surgery. X-ray films documented no significant loss of scapholunate reduction. Using local tissue only, this method is always possible, very reliable and easy to perform.

Adolescent↗
PubMed1996

Unrecognized chondral penetration by a Herbert screw in the scaphoid.

The Herbert bone screw as developed by T. Herbert in the early 1980s has been used in the treatment of scaphoid fractures and nonunions. Reports on clinical efficacy have been accompanied by discussions of technical difficulties. This study determines if the curvilinear surface of the proximal pole of the scaphoid leads to errors in screw length and penetration into the joint. The screw was inserted in cadaveric wrists using the technique described by Herbert. Plain x-ray films were taken in the anteroposterior and lateral planes and fluoroscopy was used through 360 degrees. From the imaging studies, we decided whether subchondral penetration of the screw had occurred. The scaphoids were then dissected and the dorsal poles inspected. In our six specimens, two screws were found to be penetrating subchondral bone. The plain x-ray films were accurate in five of six specimens. Fluoroscopy was accurate in all six. Fluoroscopy during placement of the Herbert screw may decrease the rate of subchondral penetration.

Bone Screws↗
PubMed2006

Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma.

PURPOSE: To retrospectively assess outcomes in 17 patients treated with scapholunate (SL) interosseous ligament repair and capsulodesis for dynamic SL instability due to trauma. METHODS: A retrospective review of 17 consecutive patients included clinical and radiographic examinations to determine outcome after SL interosseous ligament repair and dorsal capsulodesis. The average age at the time of surgery was 36 years, and the postoperative follow-up period averaged 66 months. Outcome measures included the Mayo wrist evaluation system and Disabilities of the Arm, Shoulder, and Hand questionnaire scores. Pain complaints were measured on a 10-point visual analog scale. RESULTS: Preoperative and postoperative measurements, respectively, for all patients were obtained as follows: SL gap, 2 versus 3 mm; stress views of the SL gap, 3 versus 4 mm; SL angle, 49 degrees versus 54 degrees ; capitolunate angle, 4 degrees versus 7 degrees . Grip strength was 82% of the uninjured side at the final follow-up evaluations. Pain averaged a 3 out of 10 before and after surgery. Surgery was completed an average of 22 weeks from injury. Disabilities of the Arm, Shoulder, and Hand questionnaire scores averaged 31, indicating wrist impairment. Three patients developed degenerative changes noted on postoperative x-rays. When patients were evaluated based on daily job requirements (strenuous vs nonstrenuous) there were statistically significant differences. Nonstrenuous job requirements had lower pain scores; better Disabilities of the Arm, Shoulder, and Hand questionnaire scores; better Mayo outcomes; better grip strength; and decreased SL gap on stress views. Flexion and extension of the wrist were better in the nonstrenuous group but did not reach statistical significance. CONCLUSIONS: Prior reports evaluating patients for SL ligament repair appeared to be favorable in short-term (1- to 2-y) follow-up periods. In the present report, for patients followed up for an average of 66 months after surgery, the results, clinically and radiographically, appear to deteriorate in those who place high demands on the wrists on a daily basis. Although the numbers in the present study are small, they indicate that SL ligament repair with dorsal capsulodesis may have a place for patients who have normal preoperative static unloaded x-rays and sufficient ligament for repair and who do not place high demands on the wrists on a daily basis. The ideal procedure for this difficult problem continues to remain elusive. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Adolescent↗
PubMed2005

Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability.

One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7-year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1-8) years. There were 72 patients with dynamic scapholunate instability and 45 patients with static instability. The average age was 38 years. There were 50 males and 67 females. A total of 77 (62%) patients had no to mild pain with a mean visual analogue score of 3.67 (SD=2.5). The loss in the arc of flexion-extension was due to a reduced range of flexion (mean loss 31%), while 80% of extension was maintained, compared with the contralateral side. The grip strength on the operated side was reduced by 20% of the non-operated side. There was no statistically significant difference (P>0.05) in the range of movement or the grip strength between the static and dynamic group and patients with or without legal claims. Ninety (79%) patients were satisfied with the result of the surgery (good to excellent) and 88% of the patients felt that they would have the same surgery again. We feel that these results compare favourably with the early results published from this unit and recommend this procedure for dynamic and static scapholunate instability.

Adult↗
PubMed2005

Scaphoid and capitate fracture with concurrent scapholunate dissociation.

Combined fracture of the scaphoid and capitate bones with concurrent scapholunate dissociation, but without severe dislocation, is a rare lesion which results in significant carpal instability and requires operative treatment. We report a case of this unusual injury and its functional result after 20 months.

Adult↗
PubMed2006

Dorsal capsulodesis for scapholunate instability--effect on patient disability and wrist pain.

Twenty cases of scapho-lunate instability have been reviewed, to determine the effect of dorsal capsulodesis on disability and wrist pain. The average follow-up was 41 (range 13-63) months. There was a significant improvement in the pre-operative Patient Rated Wrist Evaluation score from 108 (range 18-150) to a postoperative score of 60 (range 0-132). All wrist movements and grip strength were reduced postoperatively but only the reductions in flexion and radial deviation were statistically significant. Seventeen (85%) patients were satisfied with the operation. One patient remained unemployed after surgery. Five patients returned to their normal jobs. This study shows that dorsal capsulodesis should remain an important option in the treatment of scapholunate instability.

Adolescent↗