Flexor Carpi Radialis Tendon Stabilization of the Scapholunate Joint (Brunelli Procedure)

Patients with symptomatic static scapholunate dissociation without arthritis at the radioscaphoid or scaphotrapeziotrapezoidal joints

The dorsal capsule is incised with a radially based triangular flap to preserve the dorsal intercarpal ligament and dorsal radiocarpal ligaments (Fig. 36-1).
The scar tissue between the scaphoid and lunate is removed.
More distally, the Scaphotrapezial-trapezoida (STT) joint is exposed and any interarticular scar that formed in the dorsal angle created by the scaphoid flexion is removed.
A second volar incision is made over the flexor carpi radialis (FCR) tendon (Fig. 36-2).
The fibrous sheath of the FCR tendon is incised to the level of the trapezium and trapezoid. The deep portion of the sheath is preserved.
The FCR tendon is split longitudinally and a 7 cm tendon slip is prepared, preserving its distal attachment to the base of the second metacarpal.
The tendon slip is passed from volar to dorsal through a 2.5 mm diameter tunnel drilled in the distal pole of the scaphoid parallel to its distal articular surface (Fig. 36-3).
The scaphoid is reduced by pulling the tendon slip dorsally.
The reduced scaphoid is fixed with a Kirschner wire that crosses the distal part of the scaphoid and capitate.
The tendon slip is sutured to the fibrous remains of the lunate ligament and to the fibrous tissue of the dorsoulnar edge of the radius (Fig. 36-4).
The wounds are closed in standard fashion and a sterile dressing and plaster splint are applied.