• Karlheinz Kalb, Stephan Blank, Jörg van Schoonhoven, and Karl-Josef Prommersberger.
• Klinik für Handchirurgie, Rhön-Klinikum, Bad Neustadt an der Saale, Germany. DrKalb@web.de
• Oper Orthop Traumatol. 2009 Nov 1; 21 (4-5): 429-41.

ObjectiveStabilization of the scaphoid correcting rotary subluxation and replacement of the biomechanically essential dorsal part of the scapholunate ligament for prevention of osteoarthritis.IndicationsScapholunate dissociation without useful remnants of the ligament and reducible malalignment of the scaphoid.ContraindicationsFixed scaphoid malalignment. Osteoarthritis (SLAC [scapholunate advanced collapse] wrist).Surgical TechniqueDorsal approach to the wrist using the flap described by Berger. Correction of rotary subluxation and stabilization of the scaphoid using a distally based strip of flexor carpi radialis tendon, which is created through a separate palmar incision, and fixed to a bone anchor in the lunate through a tunnel from the palmar side of the distal pole of the scaphoid to the origin of the dorsal part of the scapholunate ligament from the scaphoid combined with transfixation of the scaphoid to the capitate and the lunate bone in corrected position using two Kirschner wires (1.6 mm). Additionally, the flexor carpi radialis strip is looped through a split in the dorsal radiotriquetral ligament and fixed to itself.Postoperative ManagementImmobilization using a below-elbow cast including the metacarpophalangeal joint of the thumb for 6 weeks. Removal of the Kirschner wires 8 weeks postoperatively, followed by physiotherapy to improve wrist motion.Results14 out of 17 patients were available for a clinical and radiologic examination after a mean follow-up time of 10.5 months (minimum 6, maximum 15 months). Two of these patients had to undergo another operative procedure in the meantime, one partial and the other total wrist fusion. The remaining twelve patients had a mean DASH Score (Disabilities of the Arm, Shoulder and Hand) of 25 (minimum 0, maximum 59 points) and a mean modified Mayo Wrist Score of 80 points (minimum 60, maximum 97 points). Contrary to the good clinical results, the final radiologic examination demonstrated a tendency toward loss of correction compared to the postoperative X-rays.

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