Scapholunate Ligament Repair-Bruneli CPT
Scapholunate Ligament Repair-Bruneli Anatomy
Scapholunate Ligament Repair-Bruneli Indications
- Acute scapholunate instability
- Subacute scapholunate instability
Scapholunate Ligament Repair -Bruneli Contraindications
- Radioscaphoid arthritis
- Capitolunate arthritis
- Chronic scapholunate instability
Scapholunate Ligament Repair-Bruneli Alternatives
Scapholunate Ligament Repair -Bruneli Pre-op Planning / Special Considerations
Scapholunate Ligament Repair-Bruneli Technique
- Pre-op antibiotics.
- Supine position with hand table.
- Anesthesia (regional or general)
- EUA compare to uninjured side.
- Touniquet high on arm.
- Consider Wrist Arthroscopy to confirm diagnosis and examine for arthritic changes.
- dorsal incision over 4th compartment
- skin flaps elevated
- extensor retinaculum incised over 3rd compartment
- distally based capsulotomy; preserve dorso lunotriquetral ligament
- confirm diagnosis
- volar incision over scaphoid tubercle and along FCR
- expose scaphoid tubercle
- k-wire 1.1mm passed along long axis of scaphoid
- overdrill with 2.9mm or 3.2mm cannulated drill
- 4mm incision over FCR 10mm proximally
- harvest volar 1/3 of FCR using Carrol tendon harvester
- bent k-wire or hewson suture passer to pass tendon through scaphoid
- chondrodesis between scaphoid and lunate with roungeur
- flex wrist to reduce lunate and pin in place with k-wire
- pass graft under dorsoradiolunotriquetral ligament
- place anchor in lunate and suture graft into lunate and itself using anchor
- remove kwire
- Repair the capsule and extensor retinaculum.
- Repair in layers.
Scapholunate Ligament Repair Complications-Bruneli
- Loss of reduction
- Pin track infection
Scapholunate Ligament Repair -Bruneli Follow-up care
- Long-arm splint in pronation for 4-6 weeks, with frequent follow-up xrays to assess reduction.
- At 6 week follow-up change to short-arm splint / cast
- Consider occupational therapy if stiffness continues 8 weeks.
Scapholunate Ligament Repair -Bruneli Outcomes
Scapholunate Ligament Repair -Bruneli Review References
Viegas SF in Master Techniques The Wrist, 2nd Ed 2002