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[Scapholunate instability. Diagnosis--classification--treatment].

J Willebrand1

  • 1Bereich Handchirurgie, Krankenhaus Waldfriede, Berlin.

Der Orthopade
|November 7, 1999
PubMed
Summary

Scapholunate instability, often due to injury, can be subtle. Treatment for this wrist condition ranges from non-operative for Stage I to surgical interventions for advanced stages.

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Area of Science:

  • Orthopedic Surgery
  • Hand and Wrist Anatomy
  • Musculoskeletal Disorders

Background:

  • Scapholunate instability results from injury to the ligament connecting the scaphoid and lunate bones.
  • Diagnosis can be challenging due to subtle widening of the scapholunate joint space.
  • Instability is classified into three distinct stages.

Purpose of the Study:

  • To outline the diagnostic methods for scapholunate instability.
  • To present a staged treatment approach for scapholunate instability.
  • To detail surgical interventions for advanced scapholunate instability.

Main Methods:

  • Physical examination for assessing wrist joint stability.
  • Radiographic imaging (X-ray) to evaluate joint space and bone alignment.
  • Arthroscopy for direct visualization and confirmation of ligamentous injury.
  • Classification of instability into three progressive stages.

Main Results:

  • Stage I scapholunate instability is amenable to non-operative management.
  • Stages II and III typically require surgical intervention.
  • Surgical options include ligament repair, ligament reconstruction (ligamentoplasty), and intra-carpal fusions.
  • In severe cases, total wrist arthrodesis may be necessary.

Conclusions:

  • Early identification and appropriate treatment are crucial for managing scapholunate instability.
  • A staged treatment protocol effectively addresses varying degrees of instability.
  • Surgical management offers solutions for advanced cases, potentially restoring wrist function or stability.

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