Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation

This study reviews the results of a four-bone ligamentous weave reconstruction for treatment of chronic complete scapholunate separation. This reconstruction between the radius, lunate, capitate, and scaphoid employs a dorsal and palmar approach weaving a long strip of the extensor carpi radialis brevis through the four bones reducing and stabilizing the scaphoid and lunate with a wire loop. Thirty-six consecutive cases of operated chronic complete scapholunate separation were evaluated in a 2- to 10-year follow-up. Average length of follow-up was 4.8 years. Average age was 34 years. Average postoperative range of motion was 52 degrees extension and 37 degrees flexion. Grip strength averaged 73% of the noninvolved side. All preoperative scapholunate gaps seen on radiographs were greater than 4 mm, at surgery greater than 1.0 cm, and the postoperative gaps radiographically averaged 3.3 mm. Eighty-six percent of patients returned to preinjury activities including heavy labor. The most significant finding was no x-ray evidence of advancing arthritic changes.