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"Locked" Scapholunate Instability Diagnosed with 4D Computed Tomography Scan
Gregory I Bain1, Sathya Vamsi Krishna2, Simon MacLean3
1Department of Orthopedic Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
Journal of Wrist Surgery
|August 13, 2019
Summary
Scapholunate instability (SLI) can present with a dislocated scaphoid, a condition previously undescribed. Advanced 4D CT imaging is crucial for diagnosing this severe form of SLI and guiding treatment.
Area of Science:
- Orthopedic Surgery
- Radiology
- Hand Surgery
Background:
- Scapholunate instability (SLI) encompasses diverse clinical and radiological findings.
- Management of SLI is stage-dependent, with scaphoid subluxation being a key indicator.
- A unique case of SLI involving a dislocated proximal scaphoid pole is presented.
Observation:
- A 20-year-old male sustained SLI after a skateboarding fall.
- 4D computed tomography (CT) revealed a dislocated proximal scaphoid pole, irreducible throughout wrist motion.
- The patient underwent surgical intervention including open reduction and SL reconstruction.
Findings:
- The 4D CT scan was instrumental in identifying the dorsal scaphoid dislocation and its lack of reducibility.
- Surgical reconstruction utilizing a flexor carpi radialis (FCR) tendon graft with the Quad tenodesis technique was performed.
- One-year follow-up demonstrated improved patient outcomes, including reduced pain and enhanced wrist function.
Implications:
- This case highlights a previously unreported presentation of dorsal scaphoid dislocation associated with SLI.
- Current SLI staging may require expansion to include a 'dislocation' or 'locked' stage.
- 4D CT imaging plays a vital role in the accurate diagnosis and assessment of SLI reducibility.