Scapholunate Reconstruction with Dorsal Capsular Flap (Blatt Procedure)

Design and mobilize proximally based capsular flap with distal margin at the STT joint. The width of the flap is 10 to 15 mm (Fig. 35-1).
If dorsal portion of SL ligament is substantial enough to repair, place suture anchors at site of ligament avulsion. If the ligament is not repairable, debride the remnants.
Place a 1 to 2 cm, V-shaped incision on the radial aspect of the wrist (Fig. 35-2).
Identify and protect branches of the radial sensory nerve.
Place two 0.045 in. pins into the radial aspect of the scaphoid, one directed toward the SL joint, the second toward the scaphocapitate (SC) joint.
Place two additional 0.045 in. pins in the dorsal aspect of the scaphoid and lunate to use as joysticks.
Reduce the SL joint under fluoroscopy and advance the SL and SC pins (Fig. 35-3).
Remove joystick pins.
Create trough on dorsal aspect of distal pole of scaphoid, distal to dorsal ridge.
Place suture anchors in trough.
Suture capsule to trough with wrist in slight extension (Fig. 35-4).
Close capsule.
Leave EPL free in subcutaneous tissues. Repair fourth compartment and close skin.
Cut pins beneath skin.