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- Berthold Bickert.
- Sektion Handchirurgie, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland. bickert@bgu-ludwigshafen.de.
- Unfallchirurg. 2018 May 1; 121 (5): 351-357.
AbstractComplete rupture of the scapholunate (SL) ligament can cause a dissociative carpal instability (CID). These ligamentous lesions are caused by a fall from a limited height of approximately 1 m or a fall, e. g. when playing handball or soccer. For a freshly injured wrist joint, the X‑ray signs of a static instability (after excluding a fracture) are a SL distance ≥3 mm, a SL angle >60°, and a dorsal displacement of the proximal scaphoid pole. Dynamic instabilities are best seen in kinematography of the wrist joint. Early ligament refixation is mandatory, ideally done in the first week after the incident or at least within the first 3 weeks. The cornerstone of the procedure is an anatomic reduction of the SL joint stabilized with K‑wires for 8 weeks. In older lesions, ligament transfer or ligamentoplasty using a tendon transfer may add to stability but have so far not achieved a reliable joint alignment despite usually good functional results. It appears that the reduction of the proximal scaphoid pole deserves more attention.
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