Skip to main content

Advertisement

SpringerLink
Log in

Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest.

Materials and methods

In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks.

Results

Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was –10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured –2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O’Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique.

Conclusion

The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6a,b
Fig. 7a,b
Fig. 8a,b

Similar content being viewed by others

References

  1. Almquist E, Bach A, Sack J, Fuhs S, Newman D (1991) Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation. J Hand Surg Am 16:322–327

    CAS  PubMed  Google Scholar 

  2. Augsburger S, Necking L, Horton J, Bach AW, Tencer AF (1992) A comparison of scaphoid-trapezium-trapezoid fusion and four-bone tendon weave for scapholunate dissociation. J Hand Surg Am 17:360–369

    CAS  PubMed  Google Scholar 

  3. Berger R (1996) The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 21:170–178

    CAS  PubMed  Google Scholar 

  4. Berger RA, Imeada T, Berglund L, An KN (1999) Constraint and material properties of subregions of the scapholunate interosseous ligament. J Hand Surg Am 24:953–962

    Article  CAS  PubMed  Google Scholar 

  5. Blatt G (1987) Capsulodesis in reconstructive hand surgery. Hand Clin 3:81–102

    CAS  PubMed  Google Scholar 

  6. Brunelli GA, Brunelli GR (1995) A new technique to correct carpal instability with scaphoid rotatory subluxation: a preliminary report. J Hand Surg Am 20:S82–S85

    CAS  PubMed  Google Scholar 

  7. Garcia-Elias M (1997) The treatment of wrist instability. J Bone Joint Surg Br 79:684–690

    Article  CAS  PubMed  Google Scholar 

  8. Garcia-Elias M, Cooney WP, An KN, Linscheid RL, Chao EYS (1989) Wrist kinematics after limited intercarpal arthrodesis. J Hand Surg Am 14:791–799

    CAS  PubMed  Google Scholar 

  9. Gickel SZ, Millender LH (1984) Ligamentous reconstruction for chronic intercarpal instability. J Hand Surg Am 9:514–527

    PubMed  Google Scholar 

  10. Green DP, O‘Brian ET (1980) Classification and management of carpal dislocations. Clin Orthop 149:55–72

    PubMed  Google Scholar 

  11. Kauer JMG (1974) The interdependence of carpal articulation chains. Acta Anat 88:481–501

    CAS  Google Scholar 

  12. Kleinman WB (1989) Long term study of chronic scapholunate instability treated by scapho-trapezio-trapezoid arthrodesis. J Hand Surg Am 14:429–445

    CAS  PubMed  Google Scholar 

  13. Kleinman WB, Carroll C IV (1990) Scapho-trapezio-trapezoid arthrodesis for treatment of chronic static and dynamic scapholunate instability: a ten year perspective on pitfalls and complications. J Hand Surg Am 15:408–414

    CAS  PubMed  Google Scholar 

  14. Linscheid RL, Dobyns JH, Beabout JW, Bryan RS (1972) Traumatic instability of the wrist. J Bone Joint Surg Am 54:1612–1632

    CAS  PubMed  Google Scholar 

  15. Mayfield JK (1980) Mechanism of carpal injuries. Clin Orthop 149:45–54

    PubMed  Google Scholar 

  16. Nachtkamp J, Klosterhalfen B, Pott S, Magin MN, Paar O (1997) Die Ligamentisation als Erklärung für die Stabilität der Periostlappenplastik beim Ersatz des fibularen Bandapparates. Chirurg 68:1146–1149

    Article  CAS  PubMed  Google Scholar 

  17. Palmer AK, Dobyns JH, Linsheid RL (1978) Management of post-traumatic instability of the wrist secondary to ligament rupture. J Hand Surg Am 3:507–532

    CAS  PubMed  Google Scholar 

  18. Ruby LK, An KN, Linscheid RL, Cooney WP, Chao YS (1987) The effect of scapholunate ligament section on scapholunate motion. J Hand Surg Am 12:767–771

    CAS  PubMed  Google Scholar 

  19. Shin SS, Moor DC, McGovern RD, Weiss AP (1998) Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft: a biomechanic and histologic study. J Hand Surg Am 23:216–221

    CAS  PubMed  Google Scholar 

  20. Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA (1995) A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 20:986–999

    CAS  PubMed  Google Scholar 

  21. Slater RR, Szabo RM, Bay BK, Laubach J (1999) Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model. J Hand Surg Am 24:232–239

    Article  PubMed  Google Scholar 

  22. Szabo RM, Slater RR, Palumbo CF, Gerlach T (2002) Dorsal intercarpal ligament capsulodesis for chronic static scapholunate dissociation: clinical results. J Hand Surg Am 27:978–984

    Article  PubMed  Google Scholar 

  23. Viegas S, Patterson R, Peterson P et al (1990) Evaluation of the biomechanical efficacy of limited intercarpal fusions for the treatment of scapho-lunate dissociation. J Hand Surg Am 15:120–128

    CAS  PubMed  Google Scholar 

  24. Walsh JJ, Berger RA, Cooney WP (2002) Current status of scapholunate interosseus ligament injuries. J Am Acad Orthop Surg 10:32–42

    PubMed  Google Scholar 

  25. Watson K, Hempton RF (1980) Limited wrist arthrodesis. I. The triscaphoid joint. J Hand Surg Am 5:320–327

    CAS  PubMed  Google Scholar 

  26. Watson K, Ryu J, Akelman E (1986) Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid. J Bone Joint Surg Am 68:345–349

    CAS  PubMed  Google Scholar 

  27. Watson K, Weinzweig J, Zeppieri J (1997) The natural progression of scaphoid instability. Hand Clin 13:39–49

    CAS  PubMed  Google Scholar 

  28. Weiss AP (1998) Scapholunate ligament reconstruction using a bone retinaculum bone autograft. J Hand Surg Am 23:205–215

    CAS  PubMed  Google Scholar 

  29. Werner FW, Short WH, Fortino MD, Palmer AK (1997) The relative contribution of selected carpal bones to global wrist motion during simulated planar and out of plane wrist motion. J Hand Surg Am 22:708–713

    CAS  PubMed  Google Scholar 

  30. Wyrick JD, Youse BD, Kiefhaber TR (1998) Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation. J Hand Surg Br 23:776–780

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    M. Lutz, F. Kralinger, J. Goldhahn, R. Zimmermann, M. Gabl & S. Pechlaner

  2. Department of Radiology, University of Innsbruck, Innsbruck, Austria

    A. Rudisch

Authors
  1. M. Lutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Kralinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Goldhahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Rudisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Gabl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Pechlaner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Lutz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lutz, M., Kralinger, F., Goldhahn, J. et al. Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest. Arch Orthop Trauma Surg 124, 197–202 (2004). https://doi.org/10.1007/s00402-003-0620-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-003-0620-y

Keywords

Search

Navigation