[Dorsal ligamentoplasty for posttraumatic scapholunate dissociation]. 2017

Ralf Bajinski, and Joachim Gülke, and Martin Mentzel, and Florian Sigloch, and Moritz Dustmann, and Nikolaus Johannes Wachter
Klinikum Stuttgart, Katharinenhospital, Klinik für Handchirurgie, Plastische und Mikrochirurgie.

Scapholunate dissociation in stages 2 and 3 may lead to posttraumatic damage if left untreated. Different types of treatment have been described, including capsulodesis, tenodesis, and others. The purpose of all procedures is to avoid palmar shift of the distal scaphoid resulting in secondary arthritis (SLAC wrist). This study aimed to evaluate a modified dorsal ligamentoplasty in second- and third-degree scapholunate dissociation in a prospective study design. Furthermore, the study aimed to find out if there is a correlation between radiological and clinical parameters at follow-up and whether or not a SLAC wrist can be avoided. From 2007 to 2011 we performed 29 dorsal ligamentoplasties in our hospital in patients with second- and third-degree scapholunate dissociation. In a prospective study design, 25 patients were followed up after an average period of 18 months. Parameters recorded preoperatively included ROM, the radiological parameters SL diastasis, SL diastasis in power grip and SL angle, the DASH score, and the VAS score. The postoperative evaluation additionally included power grip, the Mayo wrist score, and patients' subjective satisfaction. The average subjective satisfaction after surgery was good. The average postoperative ROM was 83.8 % of the ROM of the healthy wrist and decreased by 11 % compared with the preoperative level. The average postoperative grip strength was 85.7 % of the strength of the healthy hand. The VAS score was 2.7 with a significant reduction from 6.7 preoperatively. The average DASH score decreased significantly from 60 preoperatively to 22.5 postoperatively. The average Mayo wrist score after surgery was 73. All radiological parameters at follow-up were significantly better than preoperatively, although they remained in a pathological range. The Pearson correlation analysis showed no relevant correlation between clinical and radiological scores. Three cases (12 %) required revision surgery. The described modified dorsal ligamentoplasty at the carpus can be recommended in second- and third-degree scapholunate dissociation. Clinical results are comparable to other techniques, but there is only a single approach required and the complication rate is very low. The short average follow-up of 18 months must be viewed critically as the rate of SLAC wrists might be higher during longer follow-up periods.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001168 Arthritis Acute or chronic inflammation of JOINTS. Oligoarthritis,Polyarthritis,Arthritides,Oligoarthritides,Polyarthritides
D012667 Lunate Bone A moon-shaped carpal bone which is located between the SCAPHOID BONE and TRIQUETRUM BONE. Semilunar Bone,Os Lunatum,Bone, Lunate,Bone, Semilunar,Bones, Lunate,Bones, Semilunar,Lunate Bones,Semilunar Bones
D014954 Wrist Injuries Injuries to the wrist or the wrist joint. Injuries, Wrist,Injury, Wrist,Wrist Injury
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D021361 Scaphoid Bone The bone which is located most lateral in the proximal row of CARPAL BONES. Navicular Bone of Hand,Os Naviculare Manus,Os Scaphoideum,Bone, Scaphoid,Bones, Scaphoid,Hand Navicular Bone,Hand Navicular Bones,Scaphoid Bones

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