of Scapholunate Instabilities Resorting to Blatt’s Capsulodesis



Fig. 1
The dorsal capsule. The arrow shows the scaphoid: it is flexed before the capsulodesis



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Fig. 2
Blatt’s capsulodesis. This procedure allows a verticalization of this scaphoid (arrows)


The capsular repair and then the skin are fastened. The column of the thumb is maintained by a plaster cast during 6½  weeks. At that stage, the plaster cast and the wires are removed and the patient starts physiotherapy.

It would seem that American surgeons prefer to resort to a scapholunate and scaphocapitate pinning [4].



3 Results


Results depend on how long patients have been followed up. Short-term results (1–2 years) are usually favourable [6]. However, they deteriorate at midterm (5 years), especially when important daily constraints are applied to the wrists [6].

In Blatt’s original survey, which concerned twelve indications, most scapholunate instabilities are static and chronic. Long-term results were very satisfactory as extension was completely recovered and flexion loss was only 20°. Average grip strength was recovered to 80 %. Most patients returned to their pre-operatory level of daily activities [1].

The series studied are short. Some of them mostly deal with indications of pre-radiologic or dynamic instability [2, 7], others with indications of chronic static instability [1, 8]. The most important series contains 44 patients [9]. Pain, normally studied by subjective analogical scale, often improves (except in Pommerance’s scale on which it is estimated at 3/10 before and after capsulodesis [1, 10]). However, it seldom disappears [11].

Clinical improvement is constant, with a decrease of the pain in all cases, at the expense of a loss of mobility. The deficiency of post-operatory flexion reaches 11–32° depending on the series [2, 7, 9]. The deficiency of extension reaches 11–22° [2, 9]. Grip strength is not improved by the operation [11] and reaches 66 % of the contralateral strength [9].

Radiologic parameters do not modify [9] or deteriorate [6, 11] with surgery. Scapholunate diastasis is about 1 mm wider after capsulodesis, the scapholunate angle increases by 5°. In a biomechanical study in a cadaver model, Slater made a comparison between dorsal intercarpal ligament capsulodesis and Blatt’s capsulodesis. He came to the conclusion that the first method reduces the scapholunate diastasis and the improvement of the scapholunate angle is better than Blatt’s [10].

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May 13, 2017 | Posted by in ORTHOPEDIC | Comments Off on of Scapholunate Instabilities Resorting to Blatt’s Capsulodesis

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