Radiographic Evaluation of Radial Flexion Osteotomy Effect on Static Scapholunate Instability: a Preliminary Cadaveric Study

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2023 Dec 8

PMID 38063881

Authors

Rodrigo Canadillas-Rueda

Claudia Sanchez-Agesta

Maria Angeles Villazan-Cervantes

Olga Roda-Murillo

Indalecio Sanchez-Montesinos-Garcia

Pedro Hernandez-Cortes

Affiliations

Soon will be listed here.

Abstract

Introduction: The optimal treatment of chronic scapholunate instability has yet to be established. Scapholunate ligament grafts are still far from being the ideal solution. We conducted an experimental study to evaluate whether flexion-opening wedge osteotomy of the distal radius improves misalignment and avoids rotatory subluxation of the scaphoid in a cadaveric model of static scapholunate dissociative instability.

Materials And Methods: Radiographic studies were performed on 15 cryopreserved specimens after recreating a model of scapholunate instability by division of the scapholunate interosseous ligament (SLIL) and secondary stabilizers, taking radiographs at baseline, after the instability model, and after distal radius osteotomy. Static and dynamic (under controlled tendon traction) anteroposterior and lateral views were obtained to measure the length (in mm) of the carpal scaphoid and scapholunate interval, scapholunate angle, radio-lunate angle, and palmar tilt of the distal joint surface of the radius and to measure the dorsal scaphoid translation by the concentric circles method. The Wilcoxon test was used for statistical comparisons.

Results: The scapholunate interval was significantly decreased after osteotomy in all static anteroposterior views and in all lateral views under tendon traction. Dorsal scaphoid translation was significantly reduced in static lateral view in extension and in dynamic lateral view under 5-pound flexor carpi radialis tendon tension controlled by a digital dynamometer.

Conclusions: Flexion-addition osteotomy of the distal radius appears to improve carpal alignment parameters in a cadaveric model of static scapholunate instability, achieving similar values to those obtained before instability.

References

Andersson J . Treatment of scapholunate ligament injury: Current concepts. EFORT Open Rev. 2017; 2(9):382-393. PMC: 5644424. DOI: 10.1302/2058-5241.2.170016. View

Amarasooriya M, Jerome T, Tourret L . Current Concepts in Scapholunate Instability Without Arthritic Changes. Indian J Orthop. 2023; 57(4):515-526. PMC: 10050294. DOI: 10.1007/s43465-023-00839-0. View

Johnson J, Lee P, McIff T, Toby E, Fischer K . Scapholunate ligament injury adversely alters in vivo wrist joint mechanics: an MRI-based modeling study. J Orthop Res. 2013; 31(9):1455-60. DOI: 10.1002/jor.22365. View

Short W, Werner F, Green J, Masaoka S . Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am. 2002; 27(6):991-1002. PMC: 1986797. DOI: 10.1053/jhsu.2002.35878. View

Short W, Werner F, Green J, Masaoka S . Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am. 2005; 30(1):24-34. DOI: 10.1016/j.jhsa.2004.09.015. View

Short W, Werner F, Green J, Sutton L, Brutus J . Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am. 2007; 32(3):297-309. PMC: 2062528. DOI: 10.1016/j.jhsa.2006.10.024. View

Kitay A, Wolfe S . Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am. 2012; 37(10):2175-96. DOI: 10.1016/j.jhsa.2012.07.035. View

Werner F, Short W, Green J . Changes in patterns of scaphoid and lunate motion during functional arcs of wrist motion induced by ligament division. J Hand Surg Am. 2005; 30(6):1156-60. PMC: 1986800. DOI: 10.1016/j.jhsa.2005.08.005. View

Pappou I, Basel J, Deal D . Scapholunate ligament injuries: a review of current concepts. Hand (N Y). 2014; 8(2):146-56. PMC: 3653000. DOI: 10.1007/s11552-013-9499-4. View

10.

Watson H, Weinzweig J, Zeppieri J . The natural progression of scaphoid instability. Hand Clin. 1997; 13(1):39-49. View

11.

Messina J, Van Overstraeten L, Luchetti R, Fairplay T, Mathoulin C . The EWAS Classification of Scapholunate Tears: An Anatomical Arthroscopic Study. J Wrist Surg. 2014; 2(2):105-9. PMC: 3699273. DOI: 10.1055/s-0033-1345265. View

12.

Dreant N, Mathoulin C, Lucchetti R, Pegoli L . [Comparison of two arthroscopic classifications for scapholunate instability]. Chir Main. 2009; 28(2):74-7. DOI: 10.1016/j.main.2008.12.005. View

13.

Geissler W . Arthroscopic management of scapholunate instability. J Wrist Surg. 2014; 2(2):129-35. PMC: 3699262. DOI: 10.1055/s-0033-1343354. View

14.

Garcia-Elias M, Lluch A, Stanley J . Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am. 2006; 31(1):125-34. DOI: 10.1016/j.jhsa.2005.10.011. View

15.

Short W, Werner F, Fortino M, Palmer A, Mann K . A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am. 1995; 20(6):986-99. DOI: 10.1016/S0363-5023(05)80147-9. View

16.

Omori S, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H . In vivo 3-dimensional analysis of dorsal intercalated segment instability deformity secondary to scapholunate dissociation: a preliminary report. J Hand Surg Am. 2013; 38(7):1346-55. DOI: 10.1016/j.jhsa.2013.04.004. View

17.

Blevens A, Light T, Jablonsky W, Smith D, Patwardhan A, Guay M . Radiocarpal articular contact characteristics with scaphoid instability. J Hand Surg Am. 1989; 14(5):781-90. DOI: 10.1016/s0363-5023(89)80076-0. View

18.

Imada A, Eldredge J, Wells L, Moneim M . Review of surgical treatment for chronic scapholunate ligament reconstruction: a long-term study. Eur J Orthop Surg Traumatol. 2022; 33(4):787-793. DOI: 10.1007/s00590-022-03294-z. View

19.

Daly L, Daly M, Mohamadi A, Chen N . Chronic Scapholunate Interosseous Ligament Disruption: A Systematic Review and Meta-Analysis of Surgical Treatments. Hand (N Y). 2018; 15(1):27-34. PMC: 6966285. DOI: 10.1177/1558944718787289. View

20.

Szabo R, Slater Jr R, Palumbo C, Gerlach T . Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results. J Hand Surg Am. 2002; 27(6):978-84. DOI: 10.1053/jhsu.2002.36523. View