Suture Tape Augmentation for Scapholunate Ligament Repair: A Biomechanical Study.

PURPOSE: Scapholunate (SL) ligament tears in the acute setting can be treated by primary repair through various techniques. The purpose of this study was to compare repair of the SL ligament with suture anchors alone versus repair of the SL ligament augmented with suture tape. METHODS: Twelve fresh-frozen cadavers (6 matched pairs) underwent a dorsal approach to the wrist and the SL ligament was sharply dissected off of its scaphoid attachment. Six cadavers underwent direct repair of the SL ligament using 2 suture anchors. The other 6 underwent repair of the SL ligament, which was then augmented with suture tape. All specimens then underwent load to failure testing using tensile distraction forces applied by a universal testing system. Maximum load to failure and mode of failure were recorded. RESULTS: Maximum load to failure (135 N; SD, 44.94 N) for specimens that were repaired and augmented with the internal brace was higher than that for specimens in the repair-only group (68 N; SD, 14.69 N). CONCLUSIONS: Biomechanical testing demonstrated a higher maximum load to failure in SL ligament repairs augmented with suture tape compared with a repair-only technique in this cadaveric model. CLINICAL RELEVANCE: Acute SL ligament injuries may benefit from suture tape augmentation by increasing the stability of the primary repair. This may prove to be beneficial in higher-demand patients.

Locked Wrist: A Case Report and Literature Review on Pisotriquetral Loose Bodies.

Background Pisotriquetral (PT) loose bodies have been described in the literature only a few times as case reports. While PT pathology remains the differential for ulnar-sided wrist pain, it can often be difficult to diagnose, as symptoms can be variable and radiographic imaging may be negative for any findings. Case Description A 24-year-old major league baseball player presented with pain and locking of his wrist during follow through of his bat swing. Plain radiographic imaging, as well as computed tomography (CT) imaging, was negative for any pathology. Dynamic magnetic resonance imaging (MRI) demonstrated a loose body which entered the PT joint when the wrist was moved into a flexed position. This caused entrapment of the loose body and locking of the wrist. Literature Review A total of 17 reported patients in the literature have been diagnosed with a PT loose body. The clinical examination findings, radiographic findings, and surgical findings are reviewed. Case Relevance PT loose bodies can present a challenging clinical picture to diagnose. The purpose of this case report is to review the appropriate clinical workup, including common examination findings and advanced imaging techniques, to help the clinician with the diagnosis.

How to Prevent K-Wire Bounce in Oblique Supracondylar Humerus Fractures.

Supracondylar humerus fractures with an obliquely oriented fracture pattern can pose a clinical challenge in obtaining adequate fixation. Traditionally, 1.6-mm Kirchner wires are used for fracture fixation when pinning pediatric supracondylar humerus fractures. However, when pinning across obliquely oriented fractures, the angle of pin inclination may increase to the point where the 1.6-mm k-wire cannot penetrate the far cortex. We have found that, when pinning oblique supracondylar humerus fractures, utilization of a 2.0-mm k-wire can assist the surgeon in obtaining bicortical purchase. We present a cadaveric study demonstrating the maximal angles at which both 1.6-mm and 2.0-mm k-wires will penetrate the far cortex. This technical trick can give surgeons a relatively simple solution to treat these difficult fractures.