tag:blogger.com,1999:blog-17441383285613064372024-03-12T20:20:08.743-07:00Dr.Fawaz AlBalushi / Plastic & Micro Reconstructive SurgerySultanate Of OmanDr.Fawaz Al-Balushihttp://www.blogger.com/profile/12888204647738169532noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-1744138328561306437.post-48300246898353843612009-08-12T03:30:00.001-07:002009-08-12T04:46:04.001-07:00Scapholunate Band Reconstruction<p align="justify"><br />Scapholunate is the most common type of carpal instablity. Without proper Treatment it can lead to painfull arthritis.<br /><br /><strong><span style="font-size:130%;">Anatomy </span></strong></p><div><div><div><div><div><div> </div><div align="justify">The ligaments thought to be responsible for supporting the SL joint include the radioscaphocapitate (RSC) ligament, the long radiolunate ligament, the radioscapholunate (RSL) ligament (ligament of Testu), and the short radiolunate ligament . The RSL ligament has been described as a band of tissue different than the contiguous radiocarpal ligaments.</div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6ZJ-GSERw9wityA9WfuxjCCOlXjTAKCN6jnUDusoGiGUPWowTN72YzmdF7spmhSu7ZVo1NigWZ6MAnQba01pS38PnHLVrE0FASXywnL7WmbxLDCzJB9y4DkMIi5eMh2bAxDLkOwN1LS0/s1600-h/Anatomy+carpus.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 318px; FLOAT: right; HEIGHT: 320px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369032538253301554" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6ZJ-GSERw9wityA9WfuxjCCOlXjTAKCN6jnUDusoGiGUPWowTN72YzmdF7spmhSu7ZVo1NigWZ6MAnQba01pS38PnHLVrE0FASXywnL7WmbxLDCzJB9y4DkMIi5eMh2bAxDLkOwN1LS0/s320/Anatomy+carpus.jpg" /></a><br /><br /></div><div align="justify">This RSL ligament is debated to provide one of the main supports to the SL joint in some of the work by Hixon and Stewart (Hixson ML, Stewart C. Microvascular anatomy of the radioscapholunate ligament of the wrist. J Hand Surg 1990;15A:279–282.), and some debated that it RSL dosent prrovide that much of a support like Berger (Berger RA, Kauer JMG, Landsmeer JMF. Radioscapholunate ligament: a gross anatomic and histologic study of fetal and adult wrists. J Hand Surg 1991;16A:350–355.</div><div><br /></div><div align="justify"></div><div> </div><div> </div><div><br /> </div><div align="justify"><strong><span style="font-size:130%;">Classification </span></strong><br /></div><div><br /> </div><div align="justify"><strong><span style="font-size:130%;"></span></strong></div><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 320px; DISPLAY: block; HEIGHT: 227px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369029559339548738" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPSXgDN1htYFAoJZBFkKEb0IcihlYYFhj19GcmHnWkKwkRird58L3H6znmbNBjIU1K3mVCSijMvyUIycWg9PMneREpozDu9ZFzzdCuEJazA_t6lyDCy04yvZQsLP-u-EvgFs326JT_cSE/s320/classification.jpg" /><br /><div align="justify"><strong><span style="font-size:130%;">Approach</span></strong><br /><br /></div><div align="justify"></div>Good History Taking and Proper Exam will lead to the best provisional diagnosis<br /><div align="justify">a ) Identified by proper radiological investigations</div><div> </div><div align="justify">1- Normal X-ray PA, Lateral and Obliqu<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOyzteRzlK8iZcfprfKex2sNqdOC5b9bdumasp-F9Lm0YKd0HbigZ-cQWxT9Xw0Ds7-WHByvQ0cba9vrIQtlUhiBNPJyHAp2GiWAddzeA28D4_Gt2TEGurGBf75oCx1VhQyN67OCUbKGg/s1600-h/SL.jpg"><img style="MARGIN: 0px 10px 10px 0px; WIDTH: 286px; FLOAT: left; HEIGHT: 320px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369031807251050402" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOyzteRzlK8iZcfprfKex2sNqdOC5b9bdumasp-F9Lm0YKd0HbigZ-cQWxT9Xw0Ds7-WHByvQ0cba9vrIQtlUhiBNPJyHAp2GiWAddzeA28D4_Gt2TEGurGBf75oCx1VhQyN67OCUbKGg/s320/SL.jpg" /></a>e views ( It Helps to take Bilateral Views ) </div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOyzteRzlK8iZcfprfKex2sNqdOC5b9bdumasp-F9Lm0YKd0HbigZ-cQWxT9Xw0Ds7-WHByvQ0cba9vrIQtlUhiBNPJyHAp2GiWAddzeA28D4_Gt2TEGurGBf75oCx1VhQyN67OCUbKGg/s1600-h/SL.jpg"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOyzteRzlK8iZcfprfKex2sNqdOC5b9bdumasp-F9Lm0YKd0HbigZ-cQWxT9Xw0Ds7-WHByvQ0cba9vrIQtlUhiBNPJyHAp2GiWAddzeA28D4_Gt2TEGurGBf75oCx1VhQyN67OCUbKGg/s1600-h/SL.jpg"></a><br /><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 359px; DISPLAY: block; HEIGHT: 182px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369039645025455362" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvpaC1TBPg6KjN5C5W094zGyq9gcuOOCcX5N6kvvNq4fvLG9I-6kzLt9B5ITT0hsEsh8Am253oB_wc89iTXvD2TRODHANqPbk_BleWIg8iddkE7yAKPe2oZcyPCL_hnCuqfc58mYDzSWQ/s400/MRI+SL.jpg" /><br /><br /><br /><div><br /><br /><br /></div><br /><div align="justify">2- CT Acan<br /></div><br /><div align="justify">3-MRI </div><div align="justify"><br /> </div><div>b) Arthroscopy of the wrist is easy and very good in reaching for a almost a perfect diagnosis<br /></div><br /><br /><br /><div align="justify"><strong><span style="font-size:130%;">Management </span></strong></div><div align="justify"><strong><span style="font-size:130%;"></span></strong><br />If there is only sprain - then immobilisation would help </div><br /><br /><div>But if there is Tear then <strong>Surgical repair</strong> must be done </div><br /><br /><div>I use the dorsal approach to do it with the Extensor Carpi Radialis Longus Tendon as is Explained in the pic taken from Green for Hand Surgery</div><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 300px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369035761597685314" border="0" alt="" src="http://3.bp.blogspot.com/_Zki5_bk9iEw/SoKllCxmHkI/AAAAAAAAAA8/r2N5TLMx72g/s400/IMG_0298.JPG" /><br /><strong>Steps of Surgery</strong><br /><br /><div><br />1) Cut skin dorsal and the capsule with extensor retinaculum in 3-4 extensor compartement<br /></div><div>2) Open and visualize the EPL and retract it radialy<br /></div><div>3) Visualise the scaphoid – lunate<br /></div><div>4) Visualize the ECRL<br /></div><div>5) Put 4 K wires for stabalisation only</div><div>a) In lunate from above – to be used as hook for moving only<br />b) In scaphoid to counter move the lunate<br />c) Radial side entry to stabalise the scaphoid to lunate after moving the two hooks in the desired position in the lunate fossa<br />d) Radial side also from scaphoid to the capitates </div><br /><div>6) Cut ECRL (Extensor carpi radialis longus ) in ½ keeping the distal intact – cut till the muscle belly<br /></div><div>7) Make a hole by K wire in the scaphoid - and then dril a hole following the K wire after removing the wire or above it, and dril another hole with k wire first exactly like before to another point </div><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 213px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5369038478530423842" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtRo5o52LVBp8O2DR-9czOv1brlaG5YepZcYQdKDb7JWwZf1_-UJFrt-5VRg0tfiwRfDpm8ysjIl0RhgTsCicB9zGoNqZDmOJGYSY1tx4JiHO9_27GpBiicnQMGjLdRZNiEU80UWzF0Qw/s400/illustration.jpg" /><br /><div>8) Make holes in the lunate following the same principal </div><br /><div>9) Now enter a metalic wire and pull the ½ ECRL through scaphoid sdistal hole till lunate proximal hole </div><br /><div>10) Suture the tendon to Capsule ( Radiotriquitral )<br /></div><div>11) Pass the tendon back and suture it to the base of ECRL<br /><br />12) Suture the tendon here as shown in the picture<br /></div><div>13) Close the capsule over the carpal bones<br /></div><div>14) Close the extensor retinaculum<br /></div><div>15) Insert Drain<br /></div><div>16) Close skin after blood control<br /></div><div>17) Put plaster / Gipps for 10 weeks </div><div> </div><div> </div><div>Finally The Refference </div><div> </div><div>The inital Anatomy pic was taken from Berger - hand Surgery, with the explaination </div><div>The surgical method is mine </div><div>other pics are taken from the net </div><div> </div><div>take Care </div><div> </div><div>Dr.Fawaz N. Al-Balushi </div><div>Hand - Plastic and Micro Reconstructive Surgeon </div><div>Sultanate Of Oman </div></div></div></div></div></div>Dr.Fawaz Al-Balushihttp://www.blogger.com/profile/12888204647738169532noreply@blogger.com2