Debridement Pinning: Management of Recent and Unstable Perilunate Injuries

Fig. 1

Arthroscanner at the 15th post-traumatic day: triquetrolunate leak

Criteria to date the trauma [7]

Interosseous instability by Dautel (2–3) [9] (Fig. 2)

Fig. 2

Arthroscopy at the 20th post-traumatic day: midcarpal compartment—spontaneously opened interval, easy widening with the hook, hypermobility of the triquetrum (Dautel 2)

Little or no interosseous instability according to Dautel (0–1) but laxity on one of the three extrinsic bolts (Chap. 9) [9]

3 Surgical Technique

This is a simple technique. The patient is under plexus anaesthesia and in dorsal decubitus with the upper limb in an abducted position, with traction from 8 to 10 kg and upper arm support. There is a pneumatic tourniquet at the extremity of the limb.

Arthroscopy is standard, 5–6 portals (1–2, 3–4, 4–5, (6U), RMC, UMC). The following information can be obtained:

Turbidity of the synovial fluid (T0–T4) [7]
Haematic synovitis (S0–S2) [7]
Aspect of the cartilage (C0–C4)
Laxity of the extrinsic ligaments (E0–E3) and analysis of the extrinsic bolts (Chap. 9)
In radiocarpal: RSC, RL(T)L, RL(T)S, UTL, RCDorsal
In midcarpal: distal scapho-capitate, STT, DIC
SL and TL interosseous testing according to Dautel (0–3) (parallelism)

If the following conditions are completed, stabilization is made:

>T0 − > S0 − < C3

D123 (+E0) or D0123 (+>E0)

An optional shaving is made on the reinserted osseous edge. A small fissure can be ploughed with a burr. Stabilization is realized by Kirchner wire 12/10° under arthroscopic and fluoroscopic control. A correction of the DISI by joystick is possible.

Scapholunate instabilities are pinned in scapholunate and scaphocapitate.

Triquetrolunate instabilities are stabilized in triquetrolunate and triquetrohamate (Fig. 3).