A new technique to correct carpal instability with scaphoid rotary subluxation: A preliminary report

Brunelli, Giorgio; Brunelli, G

doi:10.1016/s0363-5023(95)80175-8

Cited by 232 publications

(164 citation statements)

References 9 publications

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“…After this time a myriad of different authors started to scrutinize anatomy and biomechanics of the wrist and to describe various operating methods of these instabilities, in particular instability of scapholunate, as well as the results of their treatment (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The idea of participation of the sinew of the wrist radial flexor in strengthening of the scaphoid has already been described (6,24); as mentioned earlier, however, the hypothesis proved incorrect (7).…”

Section: Discussionmentioning

confidence: 99%

Radial Wrist Extensors as a Dynamic Stabilizers of Scapholunate Complex

Elsaftawy¹

2013

Polish Journal of Surgery

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Wrist stabilization is ensured by the complex of stabilizers, both static (intrinsic and extrinsic ligaments) and dynamic ones (flexor and extensor sinews of the wrist). Extrinsic carpal ligaments link both carpal rows with forearm, while the intrinsic ones connect individual carpal bones. From among intrinsic ligaments, the most significant from clinical point of view is scapholunate ligament (scapholunate lig. -SL). Instability of the SL resulting from SL ligament tear is the most frequent type of carpal instability. If untreated or undiagnosed, it may lead to destabilization of the carpal rows, and in the final stage to massive degenerative changes with SLAC (scapholunate advanced collapse). the aim of the study was to present a hypothesis of a possible influence of radial extensors of the wrist as dynamic stabilizers for SL complex, based on which it is possible to discern the partial ligament tear with accompanying damage of static stabilizers of the complex. material and methods. This hypothesis was based on radiological tests carried out on 5 patients, with acute partial SL ligament tear, which was confirmed during wrist arthroscopy. The outcome was presented as well, with its visualization in radiological tests. Results. The picture of rotary subluxation of the scaphoid -signet ring sign in PA view and strengthening in stress position (clenched fist) was demonstrated in all 5 patients. In 2 patients who had wrist arthroscopy performed it was observed that the palmar and proximal part of SL ligament were injured, yet no damage of dorsal part was reported. In MRI tests of these patients, an additional injury of dorsal intercarpal ligament was revealed. Conclusions. Correction of the scaphoid reduction in position of clenched fist may result from influence of radial extensors of the wrist (both short and long) as dynamic stabilizers of SL complex. This imagining is a completion of the radiological symptoms so far occurring in this SL instability. In case of acute, partial scapholunate ligament tear, reduction of scapholunate subluxation and its internal fixation with the lunate and capitate for a 6-week period may be an optional procedure.

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Section: Discussionmentioning

confidence: 99%

Radial Wrist Extensors as a Dynamic Stabilizers of Scapholunate Complex

Elsaftawy¹

2013

Polish Journal of Surgery

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“…While reconstruction can favorably alter the deteriorating pattern of carpal instability, it remains limited in its capacity to restore sufficient function for the athlete as stability is achieved at the expense of mobility [24]. There are many described methods of ligament reconstruction, including tenodesis [28,29], free tendon graft [30], bone-retinaculum-bone (BRB) [31,32], reduction and association of the scaphoid and lunate ligament (RASL) [33,34], and the scapholunate axis method (SLAM) [35]. As with acute repair, dorsal capsulodesis may be performed in conjunction with any of these procedures [36].…”

Section: Operative Managementmentioning

confidence: 99%

“…In 1995, Brunelli and Brunelli presented a technique for the treatment of SL tears in which a slip of the flexor carpi radialis (FCR) tendon was transferred from volar-to-dorsal in a scaphoid tunnel and secured to the dorsal aspect of the lunate and the distal radius [28]. There have been many recent modifications to this technique.…”

Section: Operative Managementmentioning

confidence: 99%

Scapholunate and perilunate injuries in the athlete

Morrell

Moyer

Quinlan

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of the review Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. Recent findings Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Summary Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.

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“…Reconstruction of the scapholunate ligament is achieved by the use of a tendon graft, most usually from the flexor carpi radialis (FCR), passed through a substantial hole made in the scaphoid (up to 3 mm in diameter), and anchored to the lunate with a small bone anchor. This is termed as a Brunelli procedure, although other modifications are described (Brunelli and Brunelli 1995;Van Den Abbeele et al 1998) (Fig. 23).…”

Section: Wristmentioning

confidence: 99%

Imaging the Post-Operative Wrist and Hand

Campbell

2013

Medical Radiology

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A new technique to correct carpal instability with scaphoid rotary subluxation: A preliminary report

Cited by 232 publications

References 9 publications

Radial Wrist Extensors as a Dynamic Stabilizers of Scapholunate Complex

Radial Wrist Extensors as a Dynamic Stabilizers of Scapholunate Complex

Scapholunate and perilunate injuries in the athlete

Imaging the Post-Operative Wrist and Hand

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