Dorsal Scapholunate Ligament Complex Reconstruction Using Suture Tape-Augmented Autologous Free Tendon Graft for Chronic Scapholunate Dissociation.

Background: The treatment of chronic scapholunate dissociation (SLD) can be challenging due to several factors such as poor quality of ligament, malalignment of the carpus, limited surgical options, and risk of recurrent instability. Various surgical techniques have been developed, but there is ongoing debate regarding the optimal surgical technique. This study aimed to report the clinical and radiological outcomes after dorsal scapholunate (SL) ligament complex reconstruction using suture tape-augmented autologous tendon graft. Methods: The study included patients with Garcia-Elias stage 3-4 chronic SLD, SL advanced collapse (SLAC) stage 1, and a follow-up period exceeding 1 year. Pre- and postoperative SL gap, SL angle (SLA), radiolunate angle (RLA), and dorsal scaphoid translation (DST) were measured, and wrist active range of motion, Modified Mayo Wrist Score (MMWS), and visual analog scale (VAS) were evaluated. Results: Nine patients were included in this study with a mean follow-up period of 17 months (range, 15-31 months). All patients were male, with a mean age of 49 years (range, 30-62 years). Eight patients were classified as Garcia-Elias stage 4, while one was classified as SLAC 1. The median (range) of preoperative, immediate postoperative, and final follow-up measurements for SL gap, SLA, RLA, and DST were 5.4 mm (4.5-5.9), 2.1 mm (1.8-2.5), and 2.5 mm (2.0-2.8) (p = 0.008); 76° (69°-88°), 50° (32°-56°), and 54° (50°-64°) (p = 0.008); 22° (11.5°-33°), 2.8° (0.5°-3.8°), and 3.8° (2.2°-5.6°) (p = 0.008); and 2.8 mm (2.0-3.4), 0.8 mm (0.1-1.2), and 1.0 mm (0.1-2.0) (p = 0.008), respectively. Immediately after surgery, all radiological measurements showed significant improvement, which persisted up to 15 months postoperatively. The preoperative and final follow-up measurements of active flexion, extension, radial deviation, and ulnar deviation of the wrist showed significant improvement. The median preoperative and final follow-up values of MMWS were 51.1 (range, 40-60) and 88.3 (range, 85-95) (p = 0.007), respectively, and those of VAS were 7 (range, 6-8) and 2 (range, 1-3) (p = 0.007), respectively. Conclusions: Dorsal SL ligament complex reconstruction using suture tape-augmented autologous free tendon graft could be regarded as a feasible and straightforward technique for addressing irreparable chronic SLD.

Surgical repair of posttraumatic injuries of the scapholunate ligament: A literature study.

Background and research aims: Scapholunate interosseous ligament rupture can cause wrist issues like pain, strength loss, and cartilage degeneration. While various surgical treatments exist, it's unclear which method is optimal. This study aims to determine the superior treatment approach for scapholunate dissociation. Methods: In Pubmed, Embase, Scopus and Web of Science was searched for articles reporting results of surgical repair of scapholunate dissociation. Additional inclusion criteria were English- and Dutch-language articles published between January 2000 and December 2022 with at least 8 patients and at least 1 year of follow-up. Results: Seventeen articles were included, 9 covered tenodesis repair, 2 focused on capsulodesis, 3 on direct scapholunate ligament repair using bone anchors, and 3 on a combination of tenodesis and capsulodesis. No difference could be found between the types of surgical techniques in wrist mobility and grip strength. The Disability of Arm, Shoulder, and Hand score, Visual Analogue Scale for pain and Mayo wrist scores showed no clinically relevant difference. With all methods, normal radiological values were obtained after surgery. The mean scapholunate angle was less than 60° and the scapholunate gap less than 3 mm. However, at longer follow-up an increase in this angle and gap was seen again. Discussion: This review did not allow to conclude that one technique was better than another to treat scapholunate dissociation because of poor quality of the included studies. Pre- and postoperative values were not always reported, there were insufficient comparative studies, and randomized prospective studies were missing.

Midcarpal Impaction Syndromes as a Rare Cause of Ulnar-Sided Wrist Pain: A Review.

Ulnar-sided wrist pain remains a commonly encountered diagnostic challenge, and its successful management requires a comprehensive understanding of the multiple conditions that can present with this symptom. Midcarpal impaction syndromes in the form of Hamato-lunate and Triquetro-hamate impingement have both previously been reported as rare potential causes of ulnar-sided wrist pain. Despite this, they remain poorly recognized and incompletely understood. This article reviews existing literature that describes the diagnosis and management of these clinical entities.

Descriptive Epidemiology and Management of Perilunate Injuries.

INTRODUCTION: Perilunate injuries and dislocations, typically caused by high-impact trauma, can lead to acute compression of the median nerve and subsequent complications if left untreated. This study examines the epidemiology, injury mechanisms, immediate treatment, and need for carpal tunnel release in such cases. METHODS: Perilunate injuries at a single level 1 trauma center were retrospectively reviewed from 2014 to 2023. Data on patient demographics, injury mechanism, initial management, and operative management were collected. RESULTS: Thirty-three cases were analyzed, averaging 33.9 years in age. Injury mechanisms included falls (24% each from 0 to 10 feet and >10 feet, and motor vehicle accidents), bicycle-auto collisions or assaults (10%), pedestrian-auto collisions (5%), and 1 crush injury (3%). Most cases involved trans-scaphoid perilunate dislocation (predominantly Mayfield 3). Initial reduction in the emergency department succeeded in 60% of cases, with 48% showing median nerve paresthesias. Thirty-three percent underwent surgery within 24 hours, and 95% required operative intervention, including open reduction internal fixation (56%), open reduction with percutaneous pinning (30%), and closed reduction with percutaneous pinning (7%). Fifty-two percent needed carpal tunnel release. CONCLUSIONS: Prompt evaluation and treatment are crucial for perilunate injuries. If initial reduction fails, urgent operative intervention is warranted, although delayed management may be appropriate in some cases. Various operative fixation methods exist for realigning carpal bones, emphasizing the importance of tailored approaches to individual cases.

[Long-term effectiveness of Ni-Ti memory alloy tripod fixator in treatment of Kienböck disease].

Objective: To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease. Methods: The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed. There were 14 males and 8 females with an average age of 45 years (range, 20-64 years). The Lichtman staging was stage Ⅲb. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 6 cases of type B1, 2 cases of type B2, 10 cases of type B3, and 4 cases of type C2. The disease duration ranged from 18 to 50 months, with an average of 30.7 months. The operation time, intraoperative blood loss, and complications were recorded. Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation. The grip strength of bilateral hands was measured by Jamar dynamometer. The wrist pain was evaluated by visual analogue scale (VAS) score, and the wrist function was evaluated by Mayo score, and the radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion of wrist were measured. Results: The operation time was 45-60 minutes, with an average of 52.21 minutes; the intraoperative blood loss was 50-60 mL, with an average of 58.63 mL. No nerve or blood vessel injury occurred during operation. All patients were followed up 10-13 years (mean, 11.3 years). X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation. Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation (mean, 4.5 months), and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation ( P<0.05). Wrist pain relieved, scaphoid rotation and dislocation improved, and no radiocarpal joint degeneration was found during follow-up, and no internal fixator loosening, breakage, or lunate bone necrosis occurred. At last follow-up, the wrist radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion, VAS score, and grip strength of the affected side significantly improved when compared with those before operation ( P<0.05); the grip strength of the affected side recovered to 99.00%±1.25% of the healthy side. Mayo score ranged from 72 to 93, with an average of 85; 14 cases were rated as excellent, 5 good, and 3 satisfactory, the excellent and good rate was 86.4%. Conclusion: In the treatment of stage Ⅲb Kienböck's disease, the scapho-trapezio-trapezoeid joint usion using Ni-Ti memory alloy tripod fixator can effectively reduce pain, improve hand function, and prevent further deterioration, and achieve good long-term effectiveness.

Evaluation of chronic perilunate dislocations: A comparative study of single-stage, two-stage ORIF, and salvage procedures.

OBJECTIVE: This study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature. METHODS: A total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides. RESULTS: Among the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo's wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures. CONCLUSION: Staged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures. LEVEL OF EVIDENCE: 4.

Lunate-capitate arthrodesis for scaphoid nonunion: a comparative study.

BACKGROUND: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes. PATIENTS AND METHODS: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported. RESULTS: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively. CONCLUSION: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF. LEVEL OF EVIDENCE: level IV evidence.

Scaphocapitate arthrodesis with lunate preservation for Kienböck's disease: prospective outcomes study.

PURPOSE: The study evaluated the efficacy of SC arthrodesis with lunate preservation for treating patients diagnosed with stage IIIB or IIIC Kienböck's disease, who also exhibit neutral ulnar variance. The study further aimed to explore potential variations in outcomes between patients diagnosed with stage IIIB and IIIC Kienböck's disease. METHODS: Thirty-two patients diagnosed with stage IIIB (n = 19) and stage IIIC (n = 13) Kienböck's disease underwent SC arthrodesis with distal radius bone grafting stabilised by Herbert compression screws. All participants underwent pre- and post-operative assessments including VAS score for pain, ROM, grip strength, MMWS, and the Quick DASH score. Additionally, RS angle, LHI ratio, and CHI ratio were assessed. RESULTS: For all patients, the mean operative time was 73 min, follow-up was 45.6 months, time to union was 14 weeks, and time to full return to work was 24 weeks. The rate of union at the arthrodesis site was 91% (29 out of 32 patients) whilst the incidence of postoperative degenerative arthritis was 36% (8 out of 32 patients). Regarding changes in the means of outcomes from pre- to post-operatively, the VAS score decreased from 8.2 to 1.3 and grip strength improved from 36 to 79%. The RS angle was corrected from 59° to 50°. Significant improvements were noted in the mean MMWS from 45 to 75 and QuickDASH score from 78 to 21. However, no significant changes were observed in ROM, LHI, and CHI. There were no significant differences between patients with stage IIIB and stage IIIC in terms of these parameters, except for differences observed in the RS angle, LHI, and CHI preoperatively and in LHI and CHI postoperatively. CONCLUSION: Evidence level: II. Our research demonstrates that SC arthrodesis is a valuable approach for reducing pain, improving grip strength, and enhancing overall function in individuals with advanced Kienböck's disease. Importantly, our results indicate no notable differences in outcomes between patients diagnosed with stage IIIB or IIIC Kienböck's disease.

Perilunate Fracture-Dislocation: Results at Mean Follow-Up of 7 Years after ORIF.

Background: Perilunate fracture-dislocations are frequently associated with a high risk of developing post-traumatic arthritis. Current studies indicate that during mid-term follow-ups, radiological signs of arthritis do not appear to correspond with functional score. The aim of this study was to assess the occurrence of posttraumatic arthritis and the wrist function after perilunate dislocations (PLD) and fracture dislocations at a mid-term follow-up of 7 years. Methods: We report the clinical and radiological outcomes of 17 wrists treated for PLD or fracture-dislocation by open reduction and internal fixation through a dorsal approach with dorsal ligament repair. Functional outcomes were evaluated using the short version of the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), the Patient-Rated Wrist Evaluation questionnaire (PRWE) and the Mayo Wrist Score (MWS). Results of radiographs were assessed using the Herzberg Radiological Scoring Chart. Results: The MWS showed five excellent, five good, five fair and two poor results with an average score of 81%. Radiological analysis using the Herzberg classification revealed midcarpal and/or radiocarpal arthritis in 65% of cases, lunate collapse in 59% and an increase in the mean ulnar translocation ratio in 53% of the cases. Complications included one case of lunate osteonecrosis and one case of stage 3 scapholunate advanced collapse that required revision surgery. Conclusions: Although the clinical and functional outcomes are favourable at mid-term follow-up, radiological evaluation shows a progression towards osteoarthritis (OA). Further research is warranted to refine treatment strategies and investigate factors influencing the development of OA. Level of Evidence: Level IV (Therapeutic).

Three-corner arthrodesis for scapholunate and scaphoid nonunion advanced collapsed wrists: outcomes at long term follow-ups.

OBJECTIVES: This study aimed to assess clinical, functional and radiological outcomes after three-corner arthrodesis in patients suffering from symptomatic scapholunate or scaphoid non-union advanced collapsed wrists. We hypothesised that three-corner arthrodesis provided satisfactory clinical and radiological results in the long term. MATERIAL AND METHODS: This was a retrospective study of 13 patients (14 wrists) who underwent a three-corner arthrodesis between March 2004 and January 2019 with a mean follow-up of 6,7 years. Clinical assessment consisted of wrist motion, grip strength, pain and functional scores (Quick-DASH, PRWE, MWS). All complications and surgical revisions were investigated. Radiographic assessment searched for union, evaluated carpal height and ulnar translation, lunate tilt and occurrence of radio-lunate arthritis. RESULTS: At the last follow-up Quick-DASH and PRWE scores were 24,87(± 17.2) and 47.4 (± 26.9) respectively and were significantly improved. Wrist motion was 35°, 32°, 10° et 24° of flexion, extension, radial and ulnar deviation respectively. Union was obtained for 13 (92,9%) wrists. The mean radiolunate angle was 11° (-17°-34°). Three patients needed reintervention, which 2 consisted of total wrist arthrodesis due to persisting pain. Mild signs of radio-lunate arthritis were found in three patients. CONCLUSION: Three-corner arthrodesis seemed to provide satisfactory long-term functional outcomes. The union rate was high and even patients with signs of radio-lunate arthritis still had improved outcomes at the last follow-up. It could be a part of surgical options in wrists with radio- and midcarpal arthritis, among other procedures.

Radioscapholunate Arthrodesis for Management of Madelung Deformity: A Case Report.

CASE: A 32-year-old woman with bilateral Madelung deformity presented with severe pain and arthritis of the radiocarpal and distal radioulnar joints. At final follow-up, 17 months for the left and 12 months for the right wrist, she had excellent functional results with no pain. Range of motion was 30° of flexion and 30° of extension with full pronosupination. CONCLUSION: There is paucity in the literature regarding salvage procedures in adults with this deformity. We demonstrate treatment with distal ulna excision and an radioscapholunate arthrodesis. This procedure may be indicated in Madelung deformity and proximal radiocarpal and distal radioulnar joint arthritis.

Free medial femoral condyle osteocutaneous flap for repairing stage IIIB osteonecrosis of the lunate: a case report.

BACKGROUND: There are several surgical options for osteonecrosis of the lunate, and confirming the effectiveness of various surgical methods remains challenging. Here, we present a case of stage IIIB osteonecrosis of the lunate repaired with a free medial femoral condyle osteocutaneous flap. CASE PRESENTATION: A 43-year-old male construction worker was admitted to our hospital due to right wrist pain, impaired mobility, and pain aggravated by activity for 10 months. The patient was diagnosed with stage IIIB osteonecrosis of the lunate based on the orthopantomogram and magnetic resonance imaging of the right wrist. Considering the patient's medical history, physical examination, auxiliary examination, and wishes, reconstruction was performed using a free medial femoral condyle osteocutaneous flap. After the flap survived completely, the K-wires were removed one month after the operation, the external brace was removed two months after the operation, and functional wrist rehabilitation was initiated. After six months of follow-up, the wrist swelling and pain resolved, and the reconstructed lunate bone was viable. Additionally, the last follow-up was conducted in the sixth month after surgery; the affected hand grip strength improved from about 70% (28 kg) to 80% (32 kg) compared with the healthy side (40 kg); the visual analog scale score decreased from 6.5 points before the operation to 1 point; and the MAYO score increased from 60 points before the operation to 85 points. CONCLUSIONS: The success of this case reinforces the potential of the free medial femoral condyle osteocutaneous flap as a new treatment option for stage IIIB osteonecrosis of the lunate and further expands the existing treatment options. Using a free medial femoral condyle osteocutaneous flap to reconstruct the lunate and restore the carpal anatomy may.

[Trans-scapho-perilunar fracture-dislocation: a case report]. / Fractura-luxación transescafo-perilunar: reporte de un caso clínico.

Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

Post-processing of quantitative 4D-CT for initial evaluation of scapholunate Instability: Assessment of simplified approaches to data analysis.

OBJECTIVES: To evaluate the diagnostic performance of simplified post-processing approaches for quantitative wrist 4D-CT in the assessment of scapholunate instability (SLI). METHODS: A prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard. RESULTS: The SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93-0.96) compared to the standard approach (ICC values 0.65-0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes). CONCLUSION: Simpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.

Medial Femoral Trochlea Osteochondral Flap Reconstruction of the Previously Unsalvageable Kienbock-Associated Lunate With a Coronal Split.

PURPOSE: Patients with Kienbock disease can present with coronal fracture and collapse of the proximal lunate (Unified B2/Bain grade 1, 2B). Traditionally, this was considered unsalvageable. However, medial femoral trochlea (MFT) osteochondral reconstruction, used to recreate the proximal lunate surface, can be paired with reduction and repair of the coronal plane fracture, thus restoring midcarpal congruity. The purpose of this study was to report radiographic and clinical outcomes following lunate coronal fracture fixation at the time of MFT osteochondral reconstruction. METHODS: This was a retrospective study performed at a single institution. We identified patients with Kienbock disease who underwent MFT osteochondral reconstruction from 2014 to 2023. Patients were included if they had a coronal fracture of the lunate distal articular surface fixed at the time of surgery. Radiographic and clinical parameters were evaluated, including carpal height ratio, union rate, presence of heterotopic ossification, need for revision surgery, and patient-reported outcome measures. RESULTS: Thirty-three patients were included, with a mean age of 27.5 years (range: 15-41); 19 (58%) were women. Mean radiographic follow-up time was 5.8 months, and mean clinical follow-up time was 22.6 months. Union was achieved in 30/33 patients (91%). Carpal height ratio improved from 1.32 to 1.4. Two patients (6%) required reoperation, one for removal of heterotopic ossification and another for conversion to proximal row carpectomy. Patients demonstrated meaningful improvement in brief Michigan Hand Questionnaire and Patient-Reported Outcomes Measurement Information Upper Extremity scores. Range of motion before and after surgery was similar. CONCLUSIONS: Lunate coronal fracture fixation with MFT osteochondral reconstruction represents an additional management option in select patients with Kienbock disease. This technique restores the midcarpal joint during lunate reconstruction and may allow patients to avoid salvage procedures. Early radiographic and clinical outcomes are promising. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

A deep learning-based algorithm for automatic detection of perilunate dislocation in frontal wrist radiographs.

This study proposes a Deep Learning algorithm to automatically detect perilunate dislocation in anteroposterior wrist radiographs. A total of 374 annotated radiographs, 345 normal and 29 pathological, of skeletally mature adolescents and adults aged ≥16 years were used to train, validate and test two YOLOv8 deep neural models. The training set included 245 normal and 15 pathological radiographs; the pathological training set was supplemented by 240 radiographs obtained by data augmentation. The test set comprised 30 normal and 10 pathological radiographs. The first model was used for detecting the carpal region, and the second for segmenting a region between Gilula's 2nd and 3rd arcs. The output of the segmentation model, trained multiple times with varying random initial parameter values and augmentations, was then assigned a probability of being normal or pathological through ensemble averaging. In the study dataset, the algorithm achieved an overall F1-score of 0.880: 0.928 in the normal subgroup, with 1.0 precision, and 0.833 in the pathological subgroup, with 1.0 recall (or sensitivity), demonstrating that diagnosis of perilunate dislocation can be improved by automatic analysis of anteroposterior radiographs. LEVEL OF EVIDENCE: : III.

Scapholunate Ligament Reconstruction With Internal Brace Augmentation Techniques for Chronic Scapholunate Dissociation: A Clinical Follow-up Study.

INTRODUCTION: The scapholunate ligament is the most important stabilizer of the scapholunate articulation. The management of chronic irreversible injuries of this ligament in the absence of preexisting arthritis of the wrist joint remains controversial. Recently, surgeons introduced a novel surgical technique using an internal brace (IB). Several biomechanical studies on this technique have been conducted using cadavers; however, very few studies have discussed the results in detail in actual clinical practice. Therefore, herein, we investigated the radiological and functional results of patients who underwent IB augmentation as a treatment for chronic scapholunate dissociation. METHODS: This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured. RESULTS: The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions ( P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions ( P < 0.05) except for extension ( P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions ( P < 0.05) except for extension ( P = 0.602) and clenched fist ( P = 0.556). This angle improved after reconstruction in all wrist positions except for extension ( P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively). CONCLUSIONS: This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.

Isolated Unilateral Absence of Lunate: A Case Report and Review of Literature.

Isolated unilateral absence of lunate is an extremely rare condition with only one such case reported in English literature so far. The rarity of this condition can lead to diagnostic dilemma, especially if patient has an old history of trauma or surgery around the wrist, leading to unnecessary intervention and difficulty in ensuring a good surgical outcome. We present such a case and discuss the clinical pointers to the diagnosis of this condition. Level of Evidence: Level V (Therapeutic).

Automatic analysis of the scapholunate distance using 4DCT imaging: normal values in the healthy wrist.

AIM: Early diagnosis of scapholunate ligament (SLL) injuries is crucial to prevent progression to debilitating osteoarthritis. Four-Dimensional Computed Tomography (4DCT) is a promising dynamic imaging modality for assessing such injuries. Capitalizing on the known correlation between SLL injuries and an increased scapholunate distance (SLD), this study aims to develop a fully automatic approach to evaluate the SLD continuously during wrist motion and to apply it to a dataset of healthy wrists to establish reference values. MATERIALS AND METHODS: 50 healthy wrists were analysed in this study. All subjects performed radioulnar deviation (RUD), flexion-extension (FE), and clenching fist (CF) movements during 4DCT acquisition. A novel, automatic method was developed to continuously compute the SLD at five distinct locations within the scapholunate joint, encompassing a centre, volar, dorsal, proximal, and distal measurement. RESULTS: The developed algorithm successfully processed datasets from all subjects. Our results showed that the SLD remained below 2 mm and exhibited minimal changes (median ranges between 0.3 mm and 0.65 mm) during RUD and CF at all measured locations. During FE, the volar and dorsal SLD changed significantly, with median ranges of 0.90 and 1.27 mm, respectively. CONCLUSION: This study establishes a unique database of normal SLD values in healthy wrists during wrist motion. Our results indicate that, aside from RUD and CF, FE may also be important in assessing wrist kinematics. Given the labour-intensive and time-consuming nature of manual analysis of 4DCT images, the introduction of this automated algorithm enhances the clinical utility of 4DCT in diagnosing dynamic wrist injuries.

Surgical management and functional outcomes of perilunate dislocations and fracture dislocations through the dorsal approach.

BACKGROUND: Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. PURPOSE: The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. PATIENTS AND METHODS: In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. RESULTS: The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. CONCLUSION: In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. LEVEL OF EVIDENCE IV: Retrospective case series study.