engleski

Operative treatment of the lesser arc wrist injuries

Introduction: These are high energy injuries in which an axial load is applied to a hyperextended and ulnarly deviated wrist, placing the volar structures under tension and dorsal structures under compression and shear. Lesser arc injuries are capsuloligamentous disruptions following four stages: (1) the scapholunate ligament, (2) the space of Poirer, (3) the UTCC and UL ligament, and (4) lunate dislocation. In radiographs we see a difference between lunate dislocation represented by the spilled tea cup and the perilunate dislocation which is represented as a disruption of the lines of Gilula. Materials and Methods: 37 patients are presented, 2 female and 35 male. All patients were operated using a surgical approach that was dorsal, volar or a combination of the two. Using intraoperative fluoroscopy, dislocation reduction and fixation was made with Kirschner wires. Transfixation pins are placed to protect the ligament repairs and to maintain anatomical carpal alignment. In all patients disrupted scapholunate and lunotriquetral ligaments were repaired. Results: Cast or splint was removed between 4 and 6 weeks when the patient was given an orthosis to promote range of motion. Pins were removed between 6 and 8 weeks. All patients returned to normal activities between 6 and 12 months. Conclusion: All lesser arc injuries, ligament injury and bone dislocation, need to be surgically attended to achieve satisfactory range of motion at the end of treatment.

lesser arc wrist injuries; operative treatment

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