Artikel
Interosseous SL Reconstruction for Chronic Scapholunate Dissociation augmented DIC stabilized by RASL vs SwiveLock as internal splint
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Autoren
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Keiji Fujio
- Orthopaedics, Kansai Electric Power Hospital, Osaka, Japan
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Staged 3 or 4 of Scapholunate (= SL) dissociation according to 5 questions by Garcia is good candidate for reconstruction. How long should we need to keep K-wire after any ligament reconstruction? When can we achieve successful engraftment? Internal splint such as RASL or SwieveLock fixation would be hypothesized to maintaine SL reduction and achieve engraftment and analyzed their results.
Methods: Berger' s approach was applied for all cases. Partial DIC was transferred to dorsal portion of SL ligament. 12 patients of SL were fixated by RASL using double thread screw, and 6 patients were fixed using fiber tape with SwieveLock system as internal fixation. 12 cases of RASL were analyzed averaged followed up for 32.4 months. 6 cases of Swieve Lock system were analyzed averaged followed up for 15 months. The three dimensional kinematic analysis was performed after operation for each methods.
Results and Conclusions: 10/12 of RASL patients returned to previous occupation. 2 cases were converted to Swieve Lock system because of screw loosening. Breakage of double thread screw was occurred in 1 case. Postoperatively SL angle is reduced from 69 degrees to 40 degrees. SL gap is also reduced from 4.1 to 1.8 mm. There was no carpal collapse or progression to SLAC. 6/6 of SwieveLock system patients returned to previous occupation. There was no progression of SL gap except for 1 case. Result showed almost normal motion during flexion and extension. Postoperatively SL angle is reduced from 72 degrees to 40 degrees. SL gap is also reduced from 5.3 to 1.2 mm. According to 3D analysis, normal scaphoid motion center axis is dorsal scaphoid. Distance between scaphoid apex and motion axis are different among normal, RASL, SwieveLock system. Kinematics of SwieveLock system was closer to that of normal compared to RASL (Figure 1). Fiber tape with SwieveLock system was closer to normal compared to RASL, and better clinical results were obtained compared to RASL as internal splint.
