Arthroscopy and Percutaneous Pin Fixation of Scapholunate Ligament Injuries

Acute (< 3 months) partial tear or stretch injury of the scapholunate (SL) ligament where dynamic instability is present
< 3 mm SL interval
No dorsiflexion of the lunate on a lateral projection

Evaluate SL ligament through radiocarpal and mid-carpal portals (Fig. 33-1A,B).
The view through the midcarpal portal allows the surgeon to quantify the diastasis at the SL joint using a 2 mm probe and the Geissler “drive through” test (Table 33-1).
Debridement alone is indicated for SL tears with minimal evidence of SL joint instability (Geissler 1 or 2) (Fig. 33-2A,B).
Percutaneous pinning is considered when a probe can be passed between the scaphoid and the lunate and there is a step-off at the SL joint when examined through a midcarpal portal (Geissler 3).
Reduce the SL joint with percutaneously placed joysticks into the scaphoid and lunate (see Chapter 38).
Extend the scaphoid and flex the lunate. Confirm the reduction through the midcarpal portal.
Maintain the reduction with multiple 0.045 in. wires placed across the SL and scaphocapitate joints.
Use fluoroscopy to confirm reduction and placement of wires (Fig. 33-3).