Capsulo-Fibrodesis: Horizontal Proximal Carpal Row Retightening Capsulodesis with Scapholunate ‘Fibrodesis’ – A New Surgical Option for Scapholunate Dissociation

Fig. 1

Diagram demonstrating the horizontal retightening capsulodesis by dishing or suture ‘en paletot’ of the dorsal intercarpal ligament, with placement of the sutures

Fig. 2

Anteroposterior radiograph demonstrating the placement of the suture’s anchors and the closing of the scapholunate gap at 2 years after surgery

Two technical details seem important to us:

The two DIC flaps are made at the beginning of the surgery and are high on purpose (between 8 and 10 mm long): it is important to remember that at the beginning of a surgery, it is not always easy to see the DIC whether it is a healthy or a fortiori a post-traumatic wrist. We locate the ‘efficient’ section of the radial strip as we isolate the strongest section which enables, by traction, to straighten the scaphoid. The ulnar flap takes the distal one-third of the radiocarpal ligament with the proximal part of the DIC, which thus reinforces it and enables a strong overcoat suture of the two flaps and an efficient retention to reposition the scaphoid.

To correct the dorsal bascule of the lunate, we end the surgery by a ‘dorsal complementary capsulodesis’ between the two carpal rows with a suture between the dorsal side of the lunate through the re-tensed dorsal intercarpal ligament and the distal capsule at the level of the capitate. Moreover, this surgery enables to close the articular capsule of the carpus while it is never made at the radiocarpal level. The wrist is immobilized in extension on a resin cast during 6 weeks.

3 Conclusion

This recent technique has to be ratified by a clinical study under way once more time has passed. It seems to be efficient on the long term to maintain the reduction of the scapholunate gap and the verticalization of the scaphoid. Better results are observed with dynamic instabilities and with a relatively poor loss of mobility of the wrist concerning the flexion. Acute or chronic injuries that have not developed degenerative changes are approached by this technique. The intraoperative efficiency of the retightening of the dorsal intercarpal ligament associated with this new concept of fibrodesis which rests on a strong osteosuture encouraged us to abandon classic scapholunate complementary pin fixation in certain cases with good reductibility of the scaphoïd. We show you here the three different steps of this surgical technique illustrated by intraoperative views.

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