Evaluation of Various Fixation Methods in Acute Scapholunate Dissociation, A Finite Element Study.

Objective: This study aimed to compare the outcomes of fixing scapholunate with pins and screws in parallel, convergent, and divergent orientations. Materials and Methods: In this computer simulation study, the CT scan images of a healthy subject were used to construct a 3D model of the wrist joint using MIMICS software. The imposed force to scaphoid and 3D model lunate bones, as well as the scapholunate angle and distance, were compared in different surgical techniques using parallel, divergent, and convergent pins and screws. Results: In the absence of external force, the imposed stress applied to the scaphoid and lunate bones in cases of parallel pins and screws were 7.5MPa, 5.08MPa (pins), 1.134MPa, and 1.151MPa (screws), and 10.90MPa, 10.90MPa (pins), 9.7MPa, and 34.1MPa (screws) for 50N flexion force. The imposed stress in this approach is significantly lower compared to other interventions. Better outcomes were seen regarding scapholunate angle and scapholunate distance in using parallel pins or screws as well. Conclusion: In conclusion, implementing parallel pins and screws for scapholunate fixation had better results in terms of achieving carpal stability in scapholunate dissociation. However, fixation with pins and screws showed a statistically significant difference. Furthermore, a wide range of motion exercises with no additional forces can be used in the rehabilitation of patients undergoing this surgery.

Pediatric Kienböck's Disease in an 11-Year-Old Boy: A Case Report.

Kienböck's disease is a rare condition in the pediatric age group, with little agreement on its natural history and the best treatment option. Typically, these patients present with vague wrist pain and a variable degree of joint motion restriction. Diagnosis is mainly based on clinical suspicion and MRI findings, as radiographs do not show significant changes in the early stages of the disease. Prognosis is better in children than in adults due to the good healing capacity in this age group. This study will report on an 11-year-old boy diagnosed with Kienböck's disease who underwent surgical treatment to temporarily offload the diseased lunate. Clinical and radiographic recovery was observed at the six-month follow-up.

A novel classification of Kienbock's disease based on magnetic resonance imaging.

PURPOSE: We devised a classification system for Kienbock's disease using magnetic resonance imaging (MRI). Moreover, we compared it with the modified Lichtman classification and evaluated the inter-observer reliability. METHODS: Eighty-eight patients diagnosed with Kienbock's disease were included. All patients were classified using the modified Lichtman and MRI classifications. MRI staging was based on factors including partial marrow oedema, cortical integrity of the lunate, and dorsal subluxation of the scaphoid. The inter-observer reliability was evaluated. We also evaluated the presence of a displaced coronal fracture of the lunate and investigated its association with the presence of a dorsal subluxation of the scaphoid. RESULTS: Seven patients were categorized into stage I, 13 into II, 33 into IIIA, 33 into IIIB, and two into IV using the modified Lichtman classification. Six patients were categorized into stage I, 12 into II, 56 into IIIA, ten into IIIB, and four into IV using the MRI classification. The greatest shift between the stages was observed in stages IIIA and IIIB when the results of the two classification systems were compared. The inter-observer reliability of the MRI classification was greater than that of the modified Lichtman classification. Fifteen cases with a displaced coronal fracture of the lunate were identified, and a dorsal subluxation of the scaphoid was significantly more present in these patients. CONCLUSION: The MRI classification system is more reliable than is the modified Lichtman classification. MRI classification reflects carpal misalignment with higher fidelity and is more appropriate for classification into stages IIIA and IIIB.

A case report of effective intra-articular elcatonin administration in a patient with osteonecrosis of the lunate.

INTRODUCTION AND IMPORTANCE: Although corticosteroids are effective for bronchial asthma, they are associated with various side effects, such as osteonecrosis of the femoral head and tibial condyle and osteoporosis. Here, we report a patient who was on corticosteroids for a long period of time due to severe asthma, which was thought to have led to lunate osteonecrosis of both wrist joints. Calcitonin (elcatonin), an osteoporosis drug, was administered to the wrist joint. CASE PRESENTATION: Allergy to anesthetics and various non-steroidal anti-inflammatory drugs (NSAIDs) made surgical treatment not possible and pain control difficult. In addition, pain in the wrist joint interfered with activities of daily living (ADLs). When calcitonin was administered intra-articularly into the wrist joint, the pain in the wrist joint was relieved and ADLs were improved. However, the pain-suppressing effect lasted only 1 week, and pain returned to the original state by the second week after treatment. Repeated injections were necessary every 2 weeks. CLINICAL DISCUSSION: This is the first report of the effectiveness of intra-articular calcitonin in a patient with osteonecrosis of the lunate. This treatment may be applicable to patients with allergies to anesthesia and NSAIDs. CONCLUSION: In the present case, calcitonin administered intra-articularly to the wrist appeared to be effective in pain control for steroid-induced lunate osteonecrosis.

Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression.

PURPOSE: This study evaluated the mid-term functional and radiological results of arthroscopic lunate core decompression for treating Kienböck disease. METHODS: In a prospective cohort study, 40 patients with a confirmed diagnosis of Kienböck disease (Lichtman stages II to IIIb) underwent arthroscopic core decompression of the lunate bone. A cutting bur was used through the trans-4 portal with visualization from the 3-4 portal after synovectomy and debridement of radiocarpal joint using a shaver from the 6R portal. Disabilities of Arm, Shoulder, and Hand and visual analog scale scores, wrist range of motion, grip strength, radiological changes of Lichtman classification, carpal height ratio, and scapholunate angle were evaluated before and two years after the surgery. RESULTS: The mean of Disabilities of Arm, Shoulder, and Hand score improved from 52.5 ± 13 to 29.2 ± 16.3. The visual analog scale score also improved from 7.6 ± 1.8 to 2.7 ± 1.9. There was also an improvement in hand grip strength from 6.6 ± 2.7 kg to 12.3 ± 3.1 kg. Wrist range of motion in flexion, extension, ulnar deviation, and radial deviation improved significantly. Lichtman classification remained the same in 36 (90%) patients. Carpal height did not change. Intergroup evaluation showed no functional difference in response to surgery for different radiological Lichtman stages. More improvement was observed in patients with Lichtman stage II, but was not statistically significant. CONCLUSIONS: Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[Comparison of screw implantation parameters between two approaches in capitolunate arthrodesis: an imaging analysis based on CT of the normal wrist].

Objective: To compare the parameters of screw implantation in capitolunate arthrodesis between the 2nd and 3rd metacarpal bones and via the distal dorsal capitate bone approach based on CT images of the normal wrist, and provide reference for the selection of surgical approaches and planning of screw insertion trajectory. Methods: CT data of 50 patients who met the criteria between February 2022 and April 2022 were selected as the study objects. There were 30 males and 20 females, and the age ranged from 18 to 69 years (mean, 37 years). The normal wrist alignment was conformed in all CT images. All CT data from the unilateral wrist of the patients was imported into Mimics Medical 20.0 software to construct a three-dimensional plane model, in which a virtual 3.5 mm screw was implanted between the 2nd and 3rd metacarpal bones and via the distal dorsal capitate bone approach. The angle between screw and coronal, sagittal, and transverse planes, the total length of the screw, the length of the screw in the lunate bone and the capitate bone were measured. The ratios of the length of the screw in capitate bone to the length of the long axis of the capitate bone, the length of the screw in lunate bone to the length of the long axis of the lunate bone, and the length of screw in lunate bone to the length of the screw in capitate bone were calculated. Assuming that the result of screw implantation between the 2nd and 3rd metacarpal bones was better than that via the distal dorsal capitate bone approach, the difference in length of the screw in the lunate bone between the two approaches was calculated, and the superiority test was performed. Results: Compared with the distal dorsal capitate bone approach, the total length of the screw increased, the length of the screw in the capitate bone decreased, and the length of the screw in the lunate bone increased, the angle between the screw and coronal plane decreased, the angles between screw and sagittal, transverse planes increased after the screw was implanted between the 2nd and 3rd metacarpal bones. And the ratio of the length of the screw in capitate bone to the length of the long axis of capitate bone decreased, the ratio of the length of the screw in lunate bone to the length of the long axis of lunate bone increased, and the ratio of the length of the screw in lunate bone to the length of the screw in capitate bone also increased. All the differences were significant ( P<0.05). The difference in the length of the screw in the lunate bone between the two approaches was 1.86 mm [95% CI (1.54, 2.18) mm], which was greater than the superiority margin (1.35 mm). The superiority hypothesis was supported. Conclusion: Compared with the distal dorsal capitate bone approach, the screws implanted between the the 2nd and 3rd metacarpal bones in the capitolunate arthrodesis are longer in lunate bone and more vertical to the articular surface of the capitolunate joint. Theoretically, the capitolunate joint are more firmly fixed.

Concomitant Avascular Necrosis of the Lunate and Proximal Pole of the Scaphoid in a Thalassemia Minor Patient.

Avascular necrosis (AVN) of multiple carpal bones is a very rare condition. This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid that had led to severe joint space narrowing and degenerative arthritis in the radiocarpal and distal radioulnar joints (DRUJs). She was known to have thalassemia minor hemoglobinopathy. Wrist arthrodesis and distal ulna hemiresection-interposition arthroplasty (Bowers technique) for a DRUJ were offered and performed. The patient was satisfied with the clinical outcomes.

Recent Advances in Assessment and Treatment in Kienböck's Disease.

Kienböck's disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck's disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.

Closed extensor tendon rupture caused by Kienböck disease: a case report.

Kienböck disease, a rare disease that can cause chronic pain and motor dysfunction, occurs due to avascular necrosis of the lunate bone, which leads to dislocation of the carpal bone. Among various other etiologies, Kienböck disease can cause closed tendon rupture of the finger. In this report, we introduce a case of total rupture of the second extensor digitorum communis and the extensor indicis proprius tendons caused by undiagnosed Kienböck disease in an elderly female patient.

Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease.

PURPOSE: The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD). METHODS: In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n = 54) or radial osteotomy (group B; n = 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up. RESULTS: Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively. CONCLUSIONS: An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Influence of volar margin of the lunate fossa fragment fixation on distal radius fracture outcomes: A retrospective series.

BACKGROUND: Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice. AIM: To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint. METHODS: This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year. RESULTS: Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) (P ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group (P = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group (P < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group (P < 0.001). CONCLUSION: Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.

Lunate bone loss associated with Chlamydia pneumoniae infection.

Respiratory pathogens such as Chlamydia pneumoniae may activate osteoclast cells, thereby inducing bone resorption and joint inflammation. Herein is a case report of a young man with misdiagnosed persistent wrist pain without any major trauma. Investigation of the patient's medical history confirmed a recent systemic C. pneumoniae infection. Preoperative X-ray and magnetic resonance imaging (MRI) showed a substantial decrease in cancellous lunate bone compactness. A stepwise approach was undertaken considering the rapid onset of bone devascularisation and the clinical presentation. Wrist arthroscopy confirmed extensive joint inflammation associated with decreased osteochondral lunate solidity. Microbiological examination excluded joint infection. Histological analysis showed a diffuse inflammatory infiltration. Temporary mediocarpal K-wire stabilization and synovectomy were performed. Postoperative MRI confirmed lunate bone revascularization. At 6 and 12 months' follow-up the young man was pain-free and had good recovery of range of motion. In vitro and in vivo studies demonstrate that inflammatory conditions may promote osteoclast cell activity and induce bone resorption. Moreover, infection with C. pneumoniae could activate specific "osteoporotic" bone pathways. To the authors' knowledge, this is the first published case report of specific lunate bone loss induced by systemic C. pneumoniae infection. The authors proposed an etiologic explanation, and a stepwise approach was associated with good outcome.

[Osseous variations in radiological diagnostics of the wrist]. / Ossäre Normvarianten in der radiologischen Diagnostik des Handgelenks.

CLINICAL/METHODICAL ISSUE: The carpal joint is one of the most complex joints in the body comprising multiple bones that allow flexibility while simultaneously providing stability. Variations in osseous structures that may be either cause or result of pathological changes may make radiological reporting challenging. Only the knowledge of important osseous variations allows a reliable assessment of carpal imaging studies. STANDARD RADIOLOGICAL METHODS: The standard imaging technique for evaluation of osseous carpal structures is conventional radiography, which is followed by computed tomography (CT) and-under special circumstances-magnetic resonance imaging (MRI). Other imaging methods such as sonography or nuclear medicine studies do not play a significant role in clinical routine. METHODICAL INNOVATIONS: Apart from continuous reduction in effective radiation dose, there have been no significant methodical improvements in the past decade regarding imaging of osseous carpal structures in clinical routine. PRACTICAL RECOMMENDATIONS: As the initial diagnostic procedure, conventional radiography usually allows a safe and reliable diagnosis of osseous structures. Unclear or discrepant imaging findings between clinical and imaging assessment should initiate further imaging, preferably with CT. Only for certain questions or to reduce effective radiation dose in children MRI studies should be performed in clinical routine.

Hydroxyapatite deposition disease of the wrist with intraosseous migration to the lunate bone.

Hydroxyapatite deposition disease (HADD) is a mostly uniarticular, self-limiting condition caused by deposition of hydroxyapatite (HA) crystals in tendons or in the peritendinous soft tissues. Commonly, the glenohumeral joint is affected. More rarely, the HA depot can be cause of a carpal tunnel syndrome due to an acute inflammatory reaction and space-occupying soft tissue oedema. We report a case of acute HA depot located at the volar site of the right wrist with affection of the deep flexor tendons and intraosseous migration into the lunate bone in a 50-year-old female. There are two main goals of this case report: First, to remind the diagnosis of HADD as a cause of wrist pain and also of carpal tunnel syndrome, as this entity being often misdiagnosed clinically, and second, to report a rare case of intraosseous migration of HA crystals into the lunate bone.

Pathogenesis and clinical treatment progress of Kienbock’s disease / 中国组织工程研究

BACKGROUND: Kienbock’s disease is aseptic necrosis of the lunate bone due to various causes, and its pathogenesis is unknown. Because the soft tissue around the wrist articular surface is small, so it leads to poor blood supply, and the progressive necrosis is irreversible. Early specificity is poor, clinical diagnosis rate is low, and late teratogenicity and disability rate is high. The clinical diagnosis and treatment are complicated, and there are many procedures, but there is no accurate guidance. OBJECTIVE: To review the current research status of mechanism, stage and clinical diagnosis of Kienbock’s disease, to summarize the clinical treatment of Kienbock’s disease in recent years, so as to discuss the clinical efficacy of various programs and provide guidance for clinical diagnosis and treatment. METHODS: A computer-based online search of PubMed and CNKI databases from 1970 to 2019 was conducted. Key words were “Kienbock’s disease, lunate bone, necrosis, mechanism, treatment” in English and Chinese, respectively. About 900 articles were retrieved, and 52 articles eligible for the inclusion and exclusion criteria were included for review. RESULTS AND CONCLUSION: (1) The pathogenesis of Kienbock’s disease is unknown, its etiology is complex, and researchers believe that anatomy and biomechanics, and individual factors are main causes, which still need further research. (2) The Lichtman stage is widely used in Kienbock’s disease classification. The latest breakthrough in arthroscopy is expected to form a new classification standard, which can be diagnosed by X-ray, CT or MRI combined with “triple sign”. It has poor early specificity, so the rate of misdiagnosis is high, and it should be identified with wrist diseases. (3) Early-stage Kienbock’s disease usually receive conservative treatment, and advanced stage tends to undergo surgical programs, including free vascularized bone graft, the lumate resection + tendon tamponade, radial wedge and shortening osteotomy, scaphotrapeziotrapezoid fusion, proximal row carpectomy, and bone cement prosthesis replacement, and the follow-up outcomes are different, so there is still no perfect treatment program.

Anatomical relationship of palmar carpal bone landmarks used in locating the lunate and capitate during palpation: A cadaveric investigation.

STUDY DESIGN: Descriptive in situ cadaveric study. INTRODUCTION: Performing accurately directed examination and treatment to the wrist requires clinicians to orient to carpal bone structures. PURPOSE OF THE STUDY: To examine the anatomical relationships that exist within the wrist-hand complex and identify the accuracy of surface anatomy mapping strategies for localizing anatomical landmarks using a palmar approach. METHODS: Twenty-three embalmed cadavers were dissected using standardized procedures. Metal markers were placed in the most prominent palmar landmark of key carpal structures. Relationships between the most prominent palpation landmarks and the carpal bones of interest were visualized using fluoroscopy. RESULTS: The most successful methods of palmar capitate localization included the midpoint of a line from trapezium tubercle to pisiform; the midpoint of a line from scaphoid tubercle to hamate hook; or the intersection (cross) of these 2 diagonal lines, with successful capitate identification 100% (23/23) of the time. The most successful method for locating the lunate included the midpoint of a line from the radial styloid process to the ulnar styloid process, which identified the lunate in 100% (23/23) of cases. DISCUSSION: The results of this cadaveric anatomical relationship study support the use of the midpoint of a line from pisiform to trapezium tubercle, the midpoint of a line from scaphoid tubercle to hamate hook, or a combination (cross) of these lines to locate the capitate from a palmar approach. In addition, the anatomical relationships examined in this study support the use of the midpoint of a line from the radial styloid process to ulnar styloid process to locate the lunate from a palmar approach. Knowledge of these anatomical relationships may improve the clinician's confidence in locating the capitate and lunate during intercarpal examination, special testing, and treatment. CONCLUSION: Results of this study provide information of the anatomical relationships of the carpal bones from a palmar approach, giving clinicians a foundation for proper orientation to the carpal bones during clinical examination and intervention. Further research is needed to evaluate the reliability and accuracy of these methods for surface palpation on live patients.

Staging and treatment of traumatic simple Kienb(o)ck's disease / 中华创伤杂志

Aseptic necrosis of lunate bone (Kienb(o)ck's disease) is a comnon cause of wrist pain in clinic.After more than a century of research,although progress has been made in the etiology,pathogenesis and clinical treatment of lunar bone aseptic necrosis,its pathogenesis remains unclear.At present,it is generally believed that the blood supply destruction of lunar bone due to trauma is one of the causes for aseptic necrosis of lunar bone.Treatnent varies according to different classifications,yet without unified or clarified therapeutic regimen.Wrist arthroscopy is a new method for Kienb(o)ck's disease.This article reviews the different stages and treatment methods of traumatic simple Kienb(o)ck's disease,providing reference for clinical treatment.

[Open reduction and internal and external fixation combined with anchor repair of intercarpal ligament for the treatment of peripheral injury of lunate bone].

OBJECTIVE: To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy. METHODS: From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed. RESULTS: All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair. CONCLUSIONS: The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.

Trans-scaphoid Perilunate Fracture-dislocation with Concomitant Lunotriquetral Ligament Disruption: A Case Report.

We report a case of trans-scaphoid perilunate fracture-dislocation with concomitant lunotriquetral ligament disruption of the right wrist in a 44-year-old man, sustained from a 10-m fall landing on his outstretched right hand. Open reduction was performed 1 day after injury; at first the palmar dislocation of the lunate was reduced with the palmar approach. Under direct view with the dorsal approach, the scaphoid was comminuted and then treated with open reduction and internal fixation with a double threshold screw using a dorsal approach and a bone graft from the distal radius. Although the scapholunate ligament was intact, the lunotriquetral ligament was disrupted and required repair with metal suture anchors. At the 28-month follow-up evaluation, the patient had no residual pain in his wrist and returned to work. Trans-scaphoid perilunate fracture-dislocations often accompany a comminuted fracture of the scaphoid and disruptions of the intercarpal ligaments, and bone union and ligament healing time is delayed. Prolonged immobilization of the wrist may restrict its range of motion and limit daily activities. Therefore, open reduction and internal fixation with a bone graft for the scaphoid and simultaneous repair of interosseous intercarpal ligaments are essential for satisfactory recovery from perilunate fracture-dislocations.