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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Dorsal bone-ligament-bone reconstruction of chronic, isolated lunotriquetral instability technique and clinical results

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  • presenting/speaker Tom Adler - Orthoklinik Dornach AG, Dornach, Switzerland
  • Janina Riederer - Universitätsklinik für Plastische- und Handchirurgie, Inselspital, Universitätsspital Bern, Bern, Switzerland
  • Esther Vögelin - Universitätsklinik für Plastische- und Handchirurgie, Inselspital, Universitätsspital Bern, Bern, Switzerland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-625

doi: 10.3205/19ifssh0958, urn:nbn:de:0183-19ifssh09585

Published: February 6, 2020

© 2020 Adler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Isolated lunotriquetral (LT) ligament injuries are not common wrist injuries and, hence, surgical procedures range from conservative treatment over arthroscopic debridement to soft tissue reconstructions and even arthrodesis. The purpose of our case series is to present one surgical option with a bone-ligament-bone graft treating isolated chronic LT ligament instabilities.

Methods: Despite of knowledge of the more stable palmar ligament we stabilized the arthroscopically proven instability with a dorsally implanted bone-ligament-bone (BLB) graft harvested from the capitohamatal joint. The graft was fixed with one screw in each bone block and the LT joint was transfixed using a headless compression screw (HBS).

5 patients were treated at our institution between September 2009 and January 2017. All patients were assessed with range of motion (ROM), grip strength, radiographic stress views, the Michigan Hand Questionnaire (MHQ) and DASH score pre- and postoperatively.

Results and Conclusions: All patients (4 men, 29.3 (19-40) years; 1 woman, 35 years) suffered from an isolated chronic LT instability and were followed up between 6 months and 6 years after surgery.

The ROM remained minimally decreased to preoperative. The grip strength improved (34kp to 46kp). The MHQ at final follow up ranged between 66 and 100%. On average the DASH score improved from 70.3 to 33.3. Subjective pain varied between 0 and 6 using NRS depending on stress load.

3 of 5 HBS screws were removed. One patient showed a breakage of the HBS screw at last follow up with a dynamic instability of 1mm opening with radial abduction compared to the other side. The stress views of the other patients did not indicate an instability. No osteoarthritis could be seen in the final radiographs in all patients.

All patients returned to and since have kept their previous activity levels and occupation until last follow up.

All patients showed a significant improvement in DASH score and grip strength. Previous activity levels were achieved without exception, even though one breakage of the HBS screw was observed.

The dorsal BLB reconstruction can be a reasonable surgical option in patients with isolated chronic LT instabilities, preserving wrist kinematics better than an arthrodesis. However, it can be discussed whether the more complicated procedure is superior to a conventional fusion.