Scaphoidectomy and four-corner fusion Indications Proximal row carpectomy (PRC) and scaphoidectomy with four-corner fusion (4CF) are motion-preserving salvage operations for patients with proximal wrist degeneration or advanced ligamentous injury. There are variations on the 4CF involving different intercarpal (two bone,…
Treatment of scaphoid nonunion Indications Operative treatment of scaphoid nonunion varies based on the timing of the injury, bone loss at the fracture site, location of the fracture, presence of humpback deformity or an increased intrascaphoid angle, and the vascularity…
Indications A scaphoid fracture is considered acute when presenting within 6 weeks of injury. Fractures in which presentation is delayed have poorer healing potential and a higher likelihood of progressing to nonunion with or without surgical intervention. The decision to…
Indications In young individuals without arthritis, attempts at reconstruction rather than salvage should be pursued to recreate the scapholunate and lunotriquetral ligaments. Internal brace and tendon grafting is an option to reconstruct various stages of scapholunate (SL) ligament injury without…
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…
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…
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…
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…
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…
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…