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Closed Surgery Is Suboptimal for Chronic Scapholunate Instability

In this study the results of closed surgery for 11 patients with chronic scapholunate (SL) instability are reported. SL instability occurs when the interosseous ligament between these two bones (scaphoid and lunate) is torn. Closed surgery more than three months after this injury isn't usually advised. The authors report suboptimal results with the technique they tried.

Eleven patients with chronic SL instability who didn't want open surgery were included. Arthroscopy was used to remove all traces of the torn ligament. This procedure is called debridement.

Removing the torn ligament down to bleeding bone may help produce scar tissue to help stabilize the joint. The two bones were also wired together to hold them in place during healing. The wire was removed eight weeks later.

The operation was a failure for three patients. They ended up having a wrist fusion to eliminate the pain. Four of the remaining eight patients were pain free. The other four had pain with everyday activities and decreased grip strength.

Grip strength and range of motion were never back to normal. X-rays showed bone gapping in all patients during gripping activities. No one had an unstable wrist.

Some patients were followed for up to three years but the authors pointed out the need for long-term results. How long does the surgery hold up? Does arthritis set in? Do younger patients have better results? Does the repair hold up for patients who work as manual laborers? The authors hope to answer these questions as part of the follow-up for this study.

References: Nickolaos A. Darlis, MD, et al. Arthroscopic Debridement and Closed Pinning for Chronic Dynamic Scapholunate Instability. In The Journal of Hand Surgery. March 2006. Vol. 31A. No. 3. Pp. 418-424.

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