Blatt’s Capsulodesis for Chronic Scapholunate Dissociation

Deshmukh, S. C.; Givissis, Panagiotis; Belloso, D.; Stanley, John; Trail, I. A.

doi:10.1054/jhsb.1998.0183

Cited by 89 publications

(64 citation statements)

References 11 publications

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“…Subsequent studies by Moran et al [34] and Deshmukh et al [16] supported Wyrick's findings. At both short-term and intermediate follow-up, the range of motion for the flexion extension arc was decreased to 60-70 % of the unaffected side.…”

Section: Stage 4: Complete Disruption With Irreparable Ligament and Rmentioning

confidence: 76%

Scapholunate Ligament Injuries: A Review of Current Concepts

Pappou

Basel

Deal

2013

Hand (New York, N,Y.)

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Injuries to the scapholunate ligament are common, especially among young active individuals. Surgeons are faced with a difficult problem because of imperfect surgical outcomes and the high demands of this patient population. Here, we review the current concepts and newest literature on scapholunate ligament injuries as well as the classification and treatment options for each stage of scapholunate instability. Emphasis is on stages in which reconstructive rather than salvage procedures can be performed. The natural history is poorly understood; it is unknown which and how many scapholunate injuries lead to wrist arthritis (SLAC wrist). Partial injuries are rare and in small studies did well with arthroscopic treatment. Complete injuries are graded based on the acuity of the injury, the presence and reducibility of scapholunate malalignment, and, finally, cartilage status. In acute injuries, anatomic repair usually leads to satisfactory results, and many authors augment the repair with a capsulodesis technique. In chronic injuries, the presence of static malalignment usually leads to inferior outcomes. Various techniques have been devised and improved over the years. These techniques appear to provide a more anatomic reconstruction, with less loss of motion; motion is 60-80 % of the contralateral side and grip strength averages 65-90 %. Once there is cartilage loss, the surgeon only has salvage procedures to choose from, tailored to the degree of arthritis.

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Section: Stage 4: Complete Disruption With Irreparable Ligament and Rmentioning

confidence: 76%

Scapholunate Ligament Injuries: A Review of Current Concepts

Pappou

Basel

Deal

2013

Hand (New York, N,Y.)

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“…Static SL dissociation was seen on the left side in 2 patients and on the right side in 10 patients. The time from injury to surgery averaged 8 months (range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The average follow-up period after surgery was 15.8 months (range: 13-34).…”

Section: Methodsmentioning

confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months.Paired t-tests were used preoperatively, one month after pin removal, and at final followup to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.

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“…Previous reports on capsulodesis are divided between those which reproduced the good results reported by Blatt (1987), those which obtained poor results and those which suggested that capsulodesis should be used in selected patients who fulfil certain criteria (Table 3). These criteria include less than 1 to 2 years since injury, no compensation claim, not involved in heavy labour, a scapholunate angle of less than 701, a scapholunate gap less than 5 mm and a high column/row index (Deshmukh et al, 1999;Wyrick et al, 1998). While the majority of our patients had a scapholunate angle of less than 701 and a scapholunate gap of less than 5 mm, we did not measure the column/ row index and did not find that the other criteria affected the outcome in our patients.…”

Section: Discussionmentioning

confidence: 99%

“…of patients Results ROM Recommendation Lavernia et al (1992) 21 9 (1.4) (Patient satisfaction) Ã Only flexion reduced Treatment of choice Deshmukh et al (1999) 44 39% satisfied All movements reduced Only on selected patients Wyrick et al (1998) 17 12% good or excellent results All movements reduced to 60% Should not be done Wintman et al (1995) 18 7.5 (2.9) (Patient satisfaction) ÃÃ Only flexion reduced Treatment of choice Konduru et al (2005) 20 85% satisfied Flexion and radial deviation reduced Treatment of choice Ã Patient satisfaction on a scale of 0 (extremely unhappy) to 10 (extremely happy).…”

Section: Authorsmentioning

confidence: 99%

Dorsal Capsulodesis for Scapholunate Instability – Effect on Patient Disability and Wrist Pain.

Konduru

Scott

Mehdi

et al. 2006

Journal of Hand Surgery

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Twenty cases of scapho-lunate instability have been reviewed, to determine the effect of dorsal capsulodesis on disability and wrist pain. The average follow-up was 41 (range 13-63) months. There was a significant improvement in the pre-operative Patient Rated Wrist Evaluation score from 108 (range 18-150) to a postoperative score of 60 (range 0-132). All wrist movements and grip strength were reduced postoperatively but only the reductions in flexion and radial deviation were statistically significant. Seventeen (85%) patients were satisfied with the operation. One patient remained unemployed after surgery. Five patients returned to their normal jobs. This study shows that dorsal capsulodesis should remain an important option in the treatment of scapholunate instability.

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Blatt’s Capsulodesis for Chronic Scapholunate Dissociation

Cited by 89 publications

References 11 publications

Scapholunate Ligament Injuries: A Review of Current Concepts

Scapholunate Ligament Injuries: A Review of Current Concepts

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Dorsal Capsulodesis for Scapholunate Instability – Effect on Patient Disability and Wrist Pain.

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