Introduction
The scapholunate ligament is one of the most important ligaments providing stability to the wrist joint. Injuries to the ligament can result in pain and stiffness in the wrist and lead to the development of arthritis.
Indications
Scapholunate tears with resulting instability and loss of the normal connection between the scaphoid and lunate bones are best treated with surgery.
Preoperative Instructions
The procedure is usually done as day surgery, under general anaesthetic. The hospital will confirm your admission time and fasting requirements.
Procedure
An incision is made over the back of the wrist and the ligament examined. In the acute setting, a fresh tear may be repaired and the wrist wired in position. For more chronic cases, the ligament is reconstructed with a strip of tendon passed through drill holes in the carpal bones. An implanted wire is used to maintain the position of the wrist.
Postoperative Instructions
The wrist is immobilized in a plaster for the first 2 weeks and then replaced with a waterproof cast until 8 weeks after surgery. A small second procedure is then required to remove the immobilizing wire, and then several months of hand therapy will be required to recover wrist movement and strength.
Risks
The main risk in ligament reconstruction is that the reconstruction itself fails. This can lead to further pain and stiffness in the wrist and ultimately the development of wrist arthritis.
Treatment Alternatives
Long term symptom management with splinting and activity modification is an option, but given the high likelihood of degenerative arthritis, most unstable scapholunate injuries should be repaired or reconstructed.