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J Wrist Surg 2020; 09(01): 076-080
DOI: 10.1055/s-0039-3401014
Wrist and Carpal Anatomy
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Scapholunate Ligament Injury and the Effect of Scaphoid Lengthening

Matthew J. Furey
1   Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2   Western Upper Limb Facility, Sturgeon Hospital, Edmonton, Alberta, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
,
Neil J. White
1   Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Gurpreet S. Dhaliwal
1   Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
› Author Affiliations
Funding The study was funded by the University of Calgary Hand and Wrist Fellowship Fund.
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Publication History

30 July 2019

01 November 2019

Publication Date:
20 December 2019 (online)

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Abstract

Objective We hypothesized that lengthening the scaphoid in a model of scapholunate ligament injury (SLI) will result in correction of radiographic markers of dorsal intercalated segment instability (DISI) deformity.

Materials and Methods An SLI with DISI deformity was created by sectioning the SL ligament, the palmar radiocarpal ligaments, and scapho-trapezio-trapezoid ligaments of a cadaveric upper extremity (n = 5). The wrist was radiographed in both anteroposterior and lateral planes to confirm creation of SLI and DISI. The scaphoid was then osteotomized at its waist. A series of grafts (1–8 mm) were then placed at the osteotomy site. Radiographs were completed at each length. The main outcome measures were scapholunate interval (SL, mm), scapholunate angle (SLA, degrees), and radiolunate angle (RLA, degrees). These values, measured following the insertion of varying graft lengths, were compared with baseline measurements taken “post-injury” status.

Results The ability to create an SLI with DISI was confirmed in the postinjury group with a statistically significant change in RLA, SLA, and SL compared with preinjury. With osteotomy and progressive insertion of spacers, the values improved into the accepted normal ranges for RLA (6 mm) and SLA (4 mm) with scaphoid lengthening.

Conclusions In this cadaveric model of SL injury, radiographic markers of DISI were returned to within normal ranges with scaphoid osteotomy and lengthening.

Clinical Relevance The results of this study add insight into wrist kinematics in our injury model and may represent a potential future direction for surgical treatment of SLI.

Keywords

scapholunate - scaphoid - DISI