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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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The Critical Ligamentous Stabilizers of the Intercalated Segment. A Cadaveric Study

Meeting Abstract

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  • presenting/speaker Alfonso Perez - Hospital del Trabajador, Santiago, Chile
  • Rishabh Jethanandani - Hospital for Special Surgery, New York, United States
  • Emil Vutescu - Hospital for Special Surgery, New York, United States
  • Kathleen Meyers - Hospital for Special Surgery, New York, United States
  • Steve Lee - Hospital for Special Surgery, Weill Cornell Medical College, New York, United States
  • Scott Wolfe - Hospital for Special Surgery, Weill Cornell Medical College, New York, United States

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. DocIFSSH19-1176

doi: 10.3205/19ifssh0962, urn:nbn:de:0183-19ifssh09620

Published: February 6, 2020

© 2020 Perez 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

Text

Objectives/Interrogation: Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to cause changes in scaphoid or lunate posture on static radiographs. Complete injuries of the SLIL may not produce lunate extension or increases in scapholunate gap (SLG) and scapholunate angle (SLA) acutely. Disruption of secondary ligamentous stabilizers are critical.

The aim of this study was to evaluate the role in carpal posture of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT) and dorsal intercarpal (DIC) ligaments in a cadaveric SL instability model.

Methods: 30 fresh-frozen forearm specimens were randomized to 5 ligament section sequences, studying SLIL, LRL, STT and DIC. The DIC-lunate insertion (DICL) and scaphoid insertions (proximal pole and waist, DICS) were studied separately, DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral standardized radiographs were taken at baseline and repeated after each ligament was sectioned. After each step in the sequence, wrists were subject to cyclic loading (71 N load).

Radiolunate angle (RLA), scapholunate angle (SLA) and dorsal Scaphoid Translation (DST) were measured in lateral radiographs with load, scapholunate gap (SLG) was measured in loaded PA views. Statistical analysis was conducted using ANOVA for repeated measures with Bonferroni poshoc analysis.

Results and Conclusions: Complete sectioning of the SLIL did not increase RLA, SLA or SLG. Section of SLIL and LRL (p=0.002), STT (p=0.011) or DICL (p=0.02) significantly increased RLA. Dorsal intercalate segment instability (DISI) was recreated with SLIL + STT or SLIL + DICL+S disruption. SLA significantly increased when in addition to SLIL, the STT (p=0.0008) or DICL (p <0.03) were cut. SLG increased when SLIL, DICL, DICS, and STT were cut in Group 1, all ligaments sectioned (Groups 2, 3 and 5) or SLIL, LRL, STT and DICL in group 4.

In addition to SLIL, division of at least one major secondary ligament stabilizer of the scaphoid or lunate (STT, DICL or LRL) produced significant changes in lunate extension.

SLA increase was recreated when SLIL and scaphoid (STT) or lunate (DICL) ligamentous attachments were sectioned.

There is a spectrum of radiographic manifestations of Scapholunate dissociation, depending on the secondary stabilizers injured.