A 4-Anchor Suture Tape Internal Bracing Technique for Ligamentous Perilunate Injuries

A 31-year-old man presented with an acute, ligamentous perilunate dislocation and paresthesia in the median nerve distribution after a dirt bike accident and underwent closed reduction. The following morning, he was treated with carpal tunnel release and open reduction and internal fixation using a 4-anchor suture tape internal bracing treatment technique through a dorsal carpal approach. The construct consisted of a series of internal braces dunked into four carpal anchors to reinforce/recreate the scapholunate interosseous ligament, lunotriquetral interosseous ligament, and dorsal intercarpal ligament without Kirschner wire retention, with an additional limb used to resist excess scaphoid flexion. The patient was immobilized in a short arm cast for six weeks before initiating full range-of-motion and hand therapy. Full weight bearing and strengthening were allowed at 12 weeks. At six months, the patient reported minimal to no pain, was able to form a full composite fist, and could tolerate a dart thrower's motion. He demonstrated a wrist flexion-extension arc of 90o (25o flexion/65o extension) and reported complete resolution of paresthesia since surgery. No radiographic evidence of carpal instability, fracture, or peri-implant failure was observed, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) score obtained through telephone was 14 out of 100 at 32 months postoperatively.