Arthroscopy

If a patient has a history, physical examination, and diagnostic workup that are consistent with scapholunate dissociation but the radiographs are equivocal, or the question of any articular damage or degenerative changes remains, the treatment approach that is offered to the patient is a manual examination under anesthesia and an arthroscopic examination, including proximal wrist and midcarpal joint examinations. Wrist arthroscopy can assist in confirming whether or not the disruption is acute in nature. Additionally, any concomitant chondral or osteochondral lesions can be identified.

There have been preliminary reports of treatment of acute scapholunate dissociation by arthroscopically assisted closed reduction and percutaneous pinning of the scapholu-nate dissociation. If this treatment obtains some success, we believe that it is the result of an anatomic reduction of the scapholunate articulation and adequate healing of the dorsal segment of the scapholunate interosseous ligament (dSLIL) complex, the dorsal intercarpal (DIC) ligament to the dorsal aspect of the scaphoid, and the DIC to the dorsal aspect of the lunate. Although arthroscopically assisted closed reduction and percuta neous pinning of the scapholunate dissociation is offered as an alternative treatment, our treatment of choice is to confirm the diagnosis and the absence of degenerative changes, and once confirmed, to proceed to an open reduction and repair/reattachment of the dorsal component of the scapholunate interosseous ligament and of the DIC ligament, often to both its scaphoid and its lunate insertions/attachment sites.

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