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Scapholunate ligament repair

The ligament between the two bones in the wrist (scaphoid and the lunate) has been damaged by an accident. These bones should normally move together as they are joined by a ligament. When the ligament is damaged they don't. The purpose of this procedure is to try and reconstitute this ligament. If this is not performed there is a likelihood of developing arthritis in the wrist later in life. In trying to reconstitute the ligament we are trying to realign the bones so that they lie anatomically and in so doing we are hoping to prevent arthritis later on. Unfortunately there is no proof or guarantee that this occurs.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

An incision is made over the back of the wrist and the two bones identified. Two small incisions are made on the front of the wrist and through one we take half of the tendon used to reconstitute the ligament, which is then passed through a drill-hole made through the scaphoid bone. The ligament is then taken up through the scaphoid bone and fixed onto the lunate bone to try and reconstitute the ligament. The two bones are wired in place. These wires are left in for between six to eight weeks after which time they will then need to be removed.


RESULTS

Restriction in range of movement - probably about 30-40% range. The operation is very successful in helping the pain in 80% of cases.

COMPLICATIONS

  1. Fracture of the scaphoid. There is a theoretical chance of fracturing the scaphoid when drilling through it. I have never experienced this complication.
  2. Infection. As in any operation there is probably a 2-5% chance of infection.
  3. Pain. The operation is painful and will take twelve months to recover from and the original pain prior to surgery can persist.
  4. Restricted range of movement. Some people have movement that is more restricted than 30% loss after the operation.
  5. Potential damage to the blood supply to the scaphoid with avascular necrosis. This is a complication that could occur and could result in your wrist becoming stiffer and more painful.