Die Versorgung von perilunären Luxationen und Luxationsfrakturen über einen kombinierten palmaren und dorsalen Zugang

Lutz, M.; Arora, Rohit; Kammerlander, Christian; Gabl, M.; Pechlaner, S.

doi:10.1007/s00064-009-1906-1

Cited by 16 publications

(5 citation statements)

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“…In another study, the ratio of active range of wrist motion reduction was one-third compared with the opposite side, grip strength reduction ratio was 15-20% in the 25 patients (15 perilunate dislocations and ten perilunate fracture-dislocations) treated via a combined volar and dorsal surgical approach 17. In our study we achieved better results in terms of both active range of wrist motion and grip strength.…”

Section: Discussionsupporting

confidence: 47%

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Başar

Erol

et al. 2014

IJOO

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Background:Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries.Materials and Methods:9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores.Results:The physical rehabilitation was started at 6th week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°.Conclusion:The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

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Section: Discussionsupporting

confidence: 47%

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Başar

Erol

et al. 2014

IJOO

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“…Der palmare Zugang entspricht dem erweiterten Zugang zum Karpaltunnel [15]. Die Flexorensehnen und der N. medianus werden nach Spaltung des Retinaculum flexorum beseite gehalten und die palmare Kapselruptur dargestellt, diese verläuft meistens entsprechend dem Faserverlauf quer.…”

Section: Operative Therapieunclassified

“…2). Bei der de QuervainLuxationsfraktur wird von einigen Autoren nach der Kahnbeinosteosynthese bei stabilem SL-Band die Transfixation vom Os triquetrum zum Os lunatum und Os capitatum empfohlen [1, 12, 14,15]. Das subkutane Versenken der KirschnerDrahtenden ist zu empfehlen, um Pininfekte mit der Gefahr der Osteitis zu vermeiden.…”

Section: Operative Therapieunclassified

Diagnostik und Therapie von perilunären Luxationen und Luxationsfrakturen

2012

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Perilunate dislocations, dislocation fractures and lunate dislocations are rare injuries predominantly resulting from hyperextension of the wrist during high-energy trauma. Early recognition and treatment of these injuries usually results in good functional outcome despite degenerative changes on radiographs. Immediate reduction and adequate restoration of normal alignment are the key to successful healing. Surgical intervention with open reduction and ligament repair aims at stable reconstruction of the carpus. It requires broad surgical experience and a profound knowledge of normal anatomy.

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“…Schematic illustration of the bone-ligament transfer of the radio-luno-triquetral ligament (modified after Lutz et al[20])…”

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confidence: 99%

Radio-luno-triquetral bone-ligament transfer as an additional stabilizer in scapholunate-instability

Haug

Adler

Bignion

et al. 2020

Arch Orthop Trauma Surg

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Introduction Reconstruction of the scapho-lunate (SL) ligament is still challenging. Many different techniques, such as capsulodesis, tendon graft and bone-ligament-bone graft have been described to stabilize reducible SL dissociation. If primary ligament repair alone is not possible, an additional stabilizer is needed to achieve scapho-lunate stability. A new local bone-ligament transfer using half of the radio-luno-triquetral ligament is performed. The direction of traction of the transposed ligament is very similar to the original ligament. Ideal tension can be attained by fixation of the bone block at the dorsal ridge of the scaphoid. The biomechanical stability of this bone-ligament transfer shall be examined biomechanically. Material and methods Computed tomography imaging was performed using eight cadaveric forearms with a defined position of the wrist. Axial load was accomplished with tension springs attached to the extensor and flexor tendons. Three series ([a] native, [b] divided SL ligament and [c]) after reconstruction with bone-ligament transfer] were reconstructed three-dimensionally to determine the angles between radius, scaphoid and lunate. The radial distal part including a bone fragment of the radio-luno-triquetral ligament was transferred from its insertion at the distal edge of the radius to be attached to the dorsal ridge of the scaphoid. Results SL gap was widened after its transection. Average SL distance was 6.6 ± 1.6 mm. After ligament reconstruction, the gap could be narrowed significantly to 4.2 mm (± 0.7 mm). The movement of the scaphoid and lunate showed significant changes, especially in wrist flexion, fist closure and radial deviation. These deviations could be corrected by the bone ligament transfer. Conclusion Reconstruction of a transected SL ligament with a bone-ligament transfer from the radio-luno-triquetral ligament reduces SL dissociation under axial load. The described surgical technique causes low donor-side morbidity and can be considered in addition to improve stability if SL ligament suture alone does not appear sufficient. Level of evidence Level II, therapeutic investigating experimental study.

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Die Versorgung von perilunären Luxationen und Luxationsfrakturen über einen kombinierten palmaren und dorsalen Zugang

Cited by 16 publications

References 14 publications

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Diagnostik und Therapie von perilunären Luxationen und Luxationsfrakturen

Radio-luno-triquetral bone-ligament transfer as an additional stabilizer in scapholunate-instability

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