Die dorsale Kapsulodese zur Behandlung der skapholunären Instabilität

ObjectiveTo regain stability of the proximal carpal row after scapholunate ligamentrupture in order to avoid osteoarthritisand carpal collapse.IndicationsAs additional therapy in scapholunate ligamentrepair especially in patients with static, but reducible scapholunate malalignment.ContraindicationsFixed scapholunate malalignment. Osteoarthritisof the radiocarpal or the midcarpal joint.Surgical TechniqueDorsal approach to the carpal joint with release of the second, third and fourth extensor compartment and resection of the dorsal interosseous nerve. Opening of the radiocarpal joint for inspection of the chondral surfaces and the scapholunate ligamentfor possible repair. If needed, reduction of scaphoid and lunate. Repair of the scapholunate ligament. If a reduction of scaphoid and lunateis necessary, temporary Kirschner wirefixation of the scaphoid to the capitate and the lunate. The dorsal intercarpal ligamentis identified and its middle third is dissected and elevated from the triquetrumremaining attached to the distal scaphoid pole. The ulnar end of the elevated part of the dorsal intercarpal ligamentis pulled through a split in the dorsal radiotriquetral ligamentand fixed to itself. Closure of the proximal and distal third of the dorsal intercarpal ligament.Postoperative ManagementManagement Immobilization in a below-elbow cast including the metacarpophalangeal jointof the thumb for 6 weeks. Removal of the Kirschner wires, if used, 8 weeks postoperatively. Physiotherapy to improve wrist motion.ResultsMost of the reports in the literature show an improvement of pain. The effect on radiologic parameters and the development of osteoarthritisremains uncertain.