Challenge of the Week / Hand & Wrist / 4.23.2021

A 28-year-old female patient sustains an acute scapholunate injury after a fall from a horse. Intra-operatively, it is discovered that the ligament has undergone a midsubstance rupture and is not amenable to repair. Which of the following is the best next step in treatment?

    • Percutaneous pinning of the scapholunate and midcarpal joints
    • Pinning without ligament reconstruction is unlikely to restore carpal stability.

 

    • Scapholunate arthrodesis
    • Typically, arthrodesis is a salvage procedure and would not be performed unless other treatment options had failed.

 

    • Proximal row carpectomy
    • Typically, a proximal row carpectomy is used as a salvage procedure in patients over 35 years of age.

 

    • Acute ligamentous reconstruction
    • If the ligament is not amenable to repair, a reconstruction would be indicated.

     

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