Bone Graft–Bone Autograft Reconstruction

Patients with symptomatic dynamic scapholunate (SL) dissociation without arthritis at the radioscaphoid or scaphotrapeziotrapezoidal joints

Incise the third dorsal compartment and retract the extensor pollicis longus (EPL) radially (Fig. 37-1).
Incise the radial wall of the fourth compartment and retract the extensor digitorum communis tendons ulnarly.
The dorsal capsule is incised with a radially based triangular flap that spares half the dorsal intercarpal ligament and half the dorsal radiocarpal ligaments.
The area over Lister’s tubercle is marked to harvest a 20 ✖ 8 ✖ 8 mm block of bone.
Using an osteotome, the bone is harvested with the overlying periosteum and retinaculum attached.
An osteotome and curette are used to fashion troughs in both the dorsal proximal scaphoid and the radial lunate to receive the autograft (Fig. 37-2).
Kirschner wires are drilled into the scaphoid (S) and lunate (L) and are used as joysticks to reduce the SL joint, which is then pinned with two 0.045 in. wires (Fig. 37-3).
A third Kirschner wire is passed from the scaphoid into the capitate (C) for additional fixation.
Using a fine rongeur, the middle 2 to 3 mm of the cortical and cancellous bone of the autograft bone block is carefully removed, preserving the overlying periosteum and retinaculum.
The autograft is placed into the prepared trough and once seated should allow full radiocarpal motion in flexion and extension (Fig. 37-4).