Wednesday, August 12, 2009

Scapholunate Band Reconstruction

Scapholunate is the most common type of carpal instablity. Without proper Treatment it can lead to painfull arthritis.


The ligaments thought to be responsible for supporting the SL joint include the radioscaphocapitate (RSC) ligament, the long radiolunate ligament, the radioscapholunate (RSL) ligament (ligament of Testu), and the short radiolunate ligament . The RSL ligament has been described as a band of tissue different than the contiguous radiocarpal ligaments.

This RSL ligament is debated to provide one of the main supports to the SL joint in some of the work by Hixon and Stewart (Hixson ML, Stewart C. Microvascular anatomy of the radioscapholunate ligament of the wrist. J Hand Surg 1990;15A:279–282.), and some debated that it RSL dosent prrovide that much of a support like Berger (Berger RA, Kauer JMG, Landsmeer JMF. Radioscapholunate ligament: a gross anatomic and histologic study of fetal and adult wrists. J Hand Surg 1991;16A:350–355.



Good History Taking and Proper Exam will lead to the best provisional diagnosis
a ) Identified by proper radiological investigations
1- Normal X-ray PA, Lateral and Oblique views ( It Helps to take Bilateral Views )

2- CT Acan


b) Arthroscopy of the wrist is easy and very good in reaching for a almost a perfect diagnosis


If there is only sprain - then immobilisation would help

But if there is Tear then Surgical repair must be done

I use the dorsal approach to do it with the Extensor Carpi Radialis Longus Tendon as is Explained in the pic taken from Green for Hand Surgery

Steps of Surgery

1) Cut skin dorsal and the capsule with extensor retinaculum in 3-4 extensor compartement
2) Open and visualize the EPL and retract it radialy
3) Visualise the scaphoid – lunate
4) Visualize the ECRL
5) Put 4 K wires for stabalisation only
a) In lunate from above – to be used as hook for moving only
b) In scaphoid to counter move the lunate
c) Radial side entry to stabalise the scaphoid to lunate after moving the two hooks in the desired position in the lunate fossa
d) Radial side also from scaphoid to the capitates

6) Cut ECRL (Extensor carpi radialis longus ) in ½ keeping the distal intact – cut till the muscle belly
7) Make a hole by K wire in the scaphoid - and then dril a hole following the K wire after removing the wire or above it, and dril another hole with k wire first exactly like before to another point

8) Make holes in the lunate following the same principal

9) Now enter a metalic wire and pull the ½ ECRL through scaphoid sdistal hole till lunate proximal hole

10) Suture the tendon to Capsule ( Radiotriquitral )
11) Pass the tendon back and suture it to the base of ECRL

12) Suture the tendon here as shown in the picture
13) Close the capsule over the carpal bones
14) Close the extensor retinaculum
15) Insert Drain
16) Close skin after blood control
17) Put plaster / Gipps for 10 weeks
Finally The Refference
The inital Anatomy pic was taken from Berger - hand Surgery, with the explaination
The surgical method is mine
other pics are taken from the net
take Care
Dr.Fawaz N. Al-Balushi
Hand - Plastic and Micro Reconstructive Surgeon
Sultanate Of Oman