Treatment of scapho-lunate instability

Scapho-lunate dissociation is one of the most frequent reasons of carpal instability. Diagnosis is mostly based on a careful physical examination where stability of the SL joint is specifically checked through different clinical maneuvers, followed by static and dynamic radiographic examination of the wrist in a variety of positions and loading conditions aiming at demonstrating the presence of a gap between the two dissociated bones. When in doubt, arthroscopy is used. In the treatment five factors are to be considered: integrity of the dorsal SL ligament, its healing potential, status of other scaphoid stabilizers, reducibility of malaligment and cartilage status. The staging classification of SLD is also presented. On this basis the possible treatment techniques both recent and past are described, including various methods of soft tissue repair and reconstruction procedures and bony stabilization.