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Volar intercalated segment instability after scapholunate ligament reconstruction.
1Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
Journal of the Southern Orthopaedic Association
|July 23, 2002
Summary
Acute lunate dislocation requires careful surgical repair. Routine pinning of the lunotriquetral interval and dorsal radiocarpal ligament evaluation are recommended to prevent midcarpal collapse.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Wrist Biomechanics
Background:
- Acute lunate dislocations are rare but serious wrist injuries.
- Standard treatment involves open reduction, ligament repair, and capsulodesis.
- Percutaneous pinning is sometimes used for temporary stabilization.
Observation:
- An 18-year-old man with acute lunate dislocation underwent standard surgical treatment.
- Post-operatively, the patient developed midcarpal collapse with volar intercalary segment instability.
- Lateral radiographs confirmed the instability after pin removal and mobilization.
Findings:
- The initial surgical approach did not prevent delayed midcarpal instability.
- Volar intercalary segment instability occurred despite successful initial reduction and fixation.
- Scapholunate repair and lunotriquetral interval pinning may be crucial.
Implications:
- Routine pinning of the lunotriquetral interval should be considered in lunate and perilunate dislocations.
- Thorough evaluation of the dorsal radiocarpal ligament is essential during surgical repair.
- These additional measures may help prevent long-term wrist instability and collapse.