Treatment of scapholunate dissociation by ligamentous repair and capsulodesis

We believe that direct scapholunate ligamentous repair, supported by a dorsal radioscaphoid capsulodesis, should be considered for the treatment of most scapholunate dissociations when there is no osteoarthritis, regardless of the time that has elapsed since injury. We treated 24 patients by this technique between 1972 and 1988. The records of 21 were available for study. Average time from injury to surgical treatment was 17 months (range, 1 to 84 months). Results were evaluated clinically and by means of patient questionnaire and x-ray films. The significant change in range of motion was a loss of palmar flexion, which averaged 11.5 degrees. Grip strength, pain, and x-ray appearance improved in all cases. Only one patient had to change occupations after surgery because of wrist symptoms. Three had minimal x-ray degenerative changes, which did not result in increased pain or in loss of motion and grip strength. There were no complications.