Research on the Biomechanical Anatomy of the Scaphoulnate ligament applied in the treatment of Wrist instability after Perilunate dislocation

Objectives: 

Research on anatomical characteristics and biomechanics of the scapholunate ligament. Determine the mechanical characteristics of the 1/2 FCR tendon. Evaluate the results of treatment of wrist instability after perilunate dislocation.

Patients and methods: 

We studied the biomechanical anatomy of the scapholunate ligament applied in the treatment of wrist instability after perilunate dislocation for 59 patients (53 males, 06 females; mean age 37.05 years old; range, 20 to 61 years). Using a dorsal approach, open reduction and Scapholunate ligament repair for 32 cases, and reconstructing the scapholunate ligament by the 3-LT procedure for 27 cases. The perilunate dislocation was reduced and the carpal bones and midcarpal joint were held in anatomical position using two K-wires transfixing the scapholunate, lunotriquetral.

Results: 

The results showed that the majority of patients had no pain, and wrist function was restored well. After surgery, majority of patients (49 out of 59) had relief of pain. The average wrist motion was 73,240 extension, 70,310 flexion, mean grip strength was 38,62 ± 5,73kg. This was 91,18% of the normal side. There were 46 excellent, 6 good and 7 poor results. The average follow-up time was 32.35 months. Surgical procedures included open reduction, SLL repair. Average functional score is: 81.30 (very good).

Conclusion: 

A dorsal approach to the wrist provides adequate exposure for reduction of carpal bones, scapholunate repair or reconstruction. Although perilunate dislocations are challenging problems to treat, all of the patients had acceptable pain relief and achieved sufficient range of motion and strength to return to gainful employment.

Keywords: perilunate dislocation, SLL, SLL repair, SLL reconstruction