Capsulodesis with Dorsal Intercarpal Ligament in Chronic Scapholunate Instability

Fig. 1

The dorsal radio-carpal (DRC) and dorsal inter-carpal (DIC) ligaments

These landmarks are (Fig. 2):

Fig. 2

The landmarks of the capsulotomy

The middle of the section between Lister’s tubercle and the radioulnar joint, which gives the centre of the radial joint of the DRC ligament

The top of the dorsal tubercle of the triquetrum, towards which the DRC and the DIC ligaments converge

The scapho-trapezial joint, which gives the distal insertion zone of the DIC ligament

Thus, the capsule is lifted as if it were a flange with a distal joint. The proximal half of the DIC ligament is also lifted on its scaphoidal joint (Fig. 3).

Fig. 3

The drawing of the capsular flaps

Two 1.2 mm diameter Joystick pins are placed in the scaphoid and the lunate (Fig. 4) and used to reduce the scapholunate diastasis, the flexion of the scaphoid and the extension of the lunate (Fig. 5). Two parallel pins maintain the reducing of the scapholunate couple, and a scaphocapitate pin cancels out the strengths which create the flexion of the scaphoid (Fig. 6). The DIC ligament is thus introduced on the posterior horn of the lunate thanks to an intraosseous anchor (Fig. 7).

Fig. 4

The two joystick pins placed in the scaphoid and the lunat

Fig. 5

The reduction maneuver

Fig. 6

The scapholunate and scaphocapitate pinning

Fig. 7

The anchoring of the DIC ligament

The triquetral’s tip of the capsular flap is sutured thanks to a resorbing thread. It seems to us that this anatomic capsular suture a minima minimizes the loss of flexion of the wrist.

The retinaculum of the extensors is closed in the proximal half of its open section. The pins are cut under the skin so that they hamper the patient as less as possible (Fig. 8) and are removed 6 weeks later. An antebrachia-palmar splint in neutral position of the wrist which completely frees the metacarpophalangeal joints of the long fingers and the thumb is carried during 6 weeks.

Fig. 8

The pins are cut under the skin

When the pins are removed, a soft and progressive physiotherapy of the wrist begins.

3 Clinical Series

3.1 Material and Method

Our experience of this surgery rests on 40 patients among which 25 have been examined again about 41 months later. They were operated by the same surgeon between January 2002 and January 2007. They all suffered from a chronic scapholunate instability with a traumatic origin dating back to more than 3 months. The average age was 28. The delay between the trauma and the surgery was about 10 months (3 months to 5 years). Each patient was clinically evaluated in preoperative and 3, 6, 12 and 24 months after the surgery by a same independent observer who uses the computer system EVAL.

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