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Lunotriquetral ligament reconstruction options using tendon grafts

Isolated lunotriquetral (LT) ligament tears are rarely treated acutely. Therefore, the traditional treatment approaches have been to attempt ligament repair, ligament reconstruction, or LT fusion. Ligament repair is often not an available option for chronic injuries because the remaining ligamentous substance is inadequately substantive to repair. LT fusion has a relatively high complication and nonunion rate (up to 50%). LT reconstruction has traditionally been performed with…

Scapholunate ligament reconstruction

Indications See Chapter 21 Scapholunate Ligament Repair. This chapter reviews reconstruction options for stage III and IV scapholunate ligament injuries. Unlike stage I and II injuries, the ligament is not repairable because of poor tissue quality, and thus reconstruction should be attempted. Contraindications As discussed in Chapter 21 , stage I and II injuries still have good ligament quality after partial or complete injury. Therefore repair…

Scapholunate ligament repair

Introduction The scapholunate (SL) ligament is a commonly injured wrist ligament. A complete SL ligament injury that is not treated can progress to pancarpal arthritis, as described later, making the diagnosis and repair of SL ligament injuries important. The SL ligament is the primary stabilizer of the scapholunate joint. As a stabilizer , the SL ligament prevents the scaphoid and lunate from moving independently at the…

Repairing tears of the triangular fibrocartilage complex

Indications Indications for repair include tears of the triangular fibrocartilage complex (TFCC) that cause persistent pain and/or distal radioulnar joint (DRUJ) instability. Another indication for repair involves symptomatic TFCC injuries that are refractory to conservative treatments (usually at least 6 weeks of immobilization). Peripheral tears of the TFCC are amenable to repair owing to better blood supply, whereas tears of the relatively avascular central zone of…

Wrist arthroscopy

Indications Diagnostic The diagnostic indications include the following: To identify or confirm pathology that is suggested by physical examination or noninvasive radiographic imaging, such as x-ray or magnetic resonance imaging (MRI). To investigate the source of chronic pain that is thought to originate in the wrist and has persisted despite conservative measures, such as corticosteroid injections or occupational therapy (including splinting). To characterize partial and complete…

Techniques for fixation of bennett and rolando fractures

Indications Closed reduction and percutaneous pinning is indicated for any Bennett or Rolando fracture with articular step-off greater than 1 mm, fracture-dislocation of the thumb carpometacarpal (CMC) joint, or angulation/rotation greater than 10 degrees. Open reduction with internal fixation is indicated for open fractures of the thumb CMC or fractures that cannot be reduced via closed methods. Contraindications The integrity of the thumb CMC joint is…

Reconstruction of acute and chronic ulnar collateral ligament injuries of the thumb

Indications A complete tear of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb necessitates this procedure. An avulsion fracture at the attachment site of the UCL with displacement greater than 5 mm may also require repair Acute injuries are best treated with repair; chronic injuries (more than 3–6 weeks old) will likely require reconstruction. Studies on the long-term outcome of ligamentous…

Corrective osteotomy of metacarpal fracture malunion

Indications One indication is metacarpal malunion with angular, rotational, or shortening deformity, which results in functional deficits. Acceptable limits of each deformity are debatable (suggested indications for primary surgery are reviewed in Chapter 14 Techniques and Fixation of Metacarpal Fractures), but indication for surgery is dictated by functional deficits that may be improved by corrective osteotomy. Angular deformity Angulation typically occurs in the sagittal plane (dorsal…

Open reduction for metacarpophalangeal joint dislocation

Indications Indications for this procedure include: Complex (or irreducible) metacarpophalangeal (MCP) joint dislocation. Concomitant fractures that require open reduction internal fixation. Clinical examination The index finger is the most common site of this injury. Most dislocations are dorsal and occur during forced hypertension of the MCP joint. The involved joint will be painful and swollen; range of motion (ROM) will be decreased ( Fig. 15.1A–C ).…

Techniques and fixation of metacarpal fractures

Closed reduction with kirschner wire fixation of metacarpal neck and shaft fractures Indications Surgery may be indicated for fractures that have recurrent or residual displacement after an attempt at reduction, especially if the fracture displacement results in disturbance in form or function of the hand. Specific indications for surgery include rotational deformities, angular deformities, shortening, multiple fractures, and open fractures. Rotational deformity Even small amounts of…

Hemi-hamate arthroplasty

Indications Indications include: Unstable proximal interphalangeal (PIP) joint fracture–dislocations in which more than 50% of the palmar base of the middle phalanx is fractured or greater than 30 degrees of PIP joint flexion is required to maintain stability. Fracture of the palmar base that results in loss of the cup-shaped geometry and buttressing effect of the volar lip. Hemi-hamate arthroplasty restores joint congruity and stability and…

Volar plate arthroplasty of the proximal interphalangeal joint

Indications Indications for this procedure include fracture dislocations of the proximal interphalangeal (PIP) joint that are unstable and in which the volar lip (buttress) of the middle phalanx base cannot be salvaged or reconstructed with other means. Volar plate arthroplasty can be used for acute or chronic cases. Ideally, the articular surface of the head of the proximal phalanx is preserved. Clinical examination Acute injuries will…

Open reduction and internal fixation of intraarticular phalangeal fractures

Indications There are a number of indications for this procedure, including: Displaced fractures or fracture-dislocations, which are irreducible by closed reduction techniques. Fractures that displace, shorten, or angulate after successful reduction. Because of the intraarticular extension of these fractures, any loss in reduction will likely lead to an articular step-off. Any articular step-off, or gap in the articular surface greater than 1 mm, should be treated…

Dynamic external fixation of fracture-dislocation of the proximal interphalangeal joint

Indications Dynamic external fixation of the proximal interphalangeal (PIP) joint is primarily used to treat intraarticular fractures of the middle phalanx with significant comminution or joint surface impaction, fractures with disruption of the volar or dorsal articular lip, and metaphyseal fractures with limited bone stock for internal fixation. Additionally, a dynamic fixator can be used for unstable dislocations or fracture dislocations of the PIP that cannot…