Scapholunate Ligament Repair-Bruneli 25320

 scapholunate ligament tear MRI
  • synonyms:

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 
  • Irrigate.
  • 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