Article
New ligament reconstruction for midcarpal instability – a case report
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Authors
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Ahmed Naeem Atiyya
- Ain Shams University, Cairo, Egypt
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Ramy Ahmed Soliman
- Ain Shams University, Cairo, Egypt
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Islam Koriem
- Ain Shams University, Cairo, Egypt
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Hasan Abd El Hamid
- Ain Shams University, Cairo, Egypt
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Literature is scarce regarding reported cases and treatment of midcarpal instability. While diagnosis is reasonably well established but its treatment is still an unsolved problem. Poor results of soft tissue reconstruction led others to advocate arthrodesis but there is a considerable risk for radioscaphoid impingement and obliteration of the important dart throwing movement. We describe a novel technique in ligament reconstruction of the combined radiocarpal-midcarpal instability.
Methods: We are presenting a case of a 20-year old student male with a rare type of right dominant midcarpal instability (combined radiocarpal-midcarpal instability). The patient refused limited wrist fusion. A new technique for ligament reconstruction was utilized in this case using the extensor carpi radialis longus (ECRL) tendon. The tendon was used to reconstruct triple ligaments; the short radiolunate, the dorsal radiocarpal, and the dorsal intercarpal ligaments through a combined volar and dorsal approaches.
Results and Conclusions: The patient became pain free. The flexion- extension range of the wrist was 85% of the contralateral side. The wrist was stable with no clicking occurred up to 30- month follow up. The patient was satisfied with the results.
The technique in this case yielded satisfactory result at the short term. It can be an addition to the treatment of this perplexing condition. However, it needs to be applied on a larger number of patients to definitely judge its effectiveness.
