Open Reduction and Transosseous Plasty of the Dorsal Scapholunate Ligament in a Patient with Mayfield type IV Chronic Lunate Dislocation, Case Report, Literature Review and Description of Surgical Technique

Karla Luisa Quinto González
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Abstract

Introduction Perilunate dislocations represent 3% of carpal injuries. They begin in a radial direction, destabilizing the scapholunate interval, and as the injury continues, there is a progressive sequence of instability, altering the anatomy of the carpus, causing significant functional deterioration. The acute diagnosis goes unnoticed, evolving into its chronic form. There are few reports of treatment in its chronic phase with a limited number of patients and follow-up evaluation is often limited. Objective We present a case of late diagnosis of chronic lunate dislocation that was managed surgically and review of the existing literature for diagnosis and treatment, as well as the surgical technique for its resolution. Clinical case 66-year-old male, fall from the plane of support, hyperextension mechanism of the right wrist, 2 months of evolution causing pain, progressive increase in volume, functional limitation. Treated with non-steroidal anti-inflammatory drugs for four weeks without improvement. Radiographically, loss of lunate joint congruity - capitate. Magnetic resonance images of avascular necrosis of the lunate. Diagnosing chronic semilunar dislocation of the right hand. Preoperative Quick-Dash 70.4 pts. A double dorsal and volar approach is performed to release the carpal tunnel, place a transosseous cerclage, and three 1.6 mm Kirschner pins in the scapholunate interval; semilunopyramidal and scaphocapitate. Immobilization with antebrachipalmar splint, removal of Kirschner pins at 7 weeks and referral to physical rehabilitation. 20 postoperative weeks, range of motion with flexion of 35° and extension of 30°, without visible sequelae to mobilization, and with Quick-Dash 20.4. Conclusion Early diagnosis and treatment are necessary to prevent the potential risk of avascular necrosis of the lunate and scaphoid, and secondary osteoarthritis. Reconstruction of the chronic pathology of lunate dislocation and scapholunate ligament (SL) remains a major challenge. There are unresolved issues regarding when to perform reconstruction rather than repair and therefore treatment remains controversial.
一名 Mayfield IV 型慢性月骨脱位患者的肩胛背侧韧带切开复位和经骨韧带成形术,病例报告、文献综述和手术技术描述
简介:腕骨周围脱位占腕骨损伤的3%。这些脱位从桡骨方向开始,破坏肩胛骨间隙的稳定性,随着损伤的持续,不稳定性会逐渐增加,改变腕骨的解剖结构,导致功能严重退化。急性期的诊断不被重视,逐渐演变为慢性期。有关慢性期治疗的报道很少,患者人数有限,随访评估也往往有限。目的 我们介绍一例晚期诊断的慢性月骨脱位患者,该患者通过手术进行了治疗,并回顾了现有的诊断和治疗文献,以及解决该问题的手术技术。临床病例 66 岁男性,从支撑平面跌落,右腕过度伸展机制,2 个月的演变导致疼痛,体积逐渐增大,功能受限。使用非甾体类抗炎药物治疗四周未见好转。影像学检查显示,新月关节-头状关节丧失了一致性。磁共振图像显示月骨无血管性坏死。诊断为右手慢性半月脱位。术前快速冲刺 70.4 pts。采用背侧和外侧双入路,松解腕管,在肩胛骨间隙、半月状和肩胛骨间隙放置经骨膜环扎带和三根1.6毫米的Kirschner针。使用前臂夹板进行固定,7 周后拔除 Kirschner 针,并转入物理康复治疗。术后 20 周,活动范围为屈曲 35°,伸展 30°,活动后无明显后遗症,Quick-Dash 20.4。结论 为预防月骨和肩胛骨血管性坏死以及继发性骨关节炎的潜在风险,早期诊断和治疗是必要的。月骨脱位和肩胛韧带(SL)的慢性病理重建仍是一大挑战。关于何时进行重建而非修复的问题尚未解决,因此治疗方法仍存在争议。
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