Abstract
Scapho-lunate Dissociation is an uncommon carpal instability, but produces significant functional loss and early post-traumatic arthritis. Traditional soft tissue reconstructions have a mixed history of success, and are associated with significant loss of range of motion making sport difficult. This study reports use of modified Brunelli reconstruction that allows return to professional contact sport
The Brunelli reconstruction tethers proximally from the lunate attachment of the FCR graft. The modification anchors the tendon graft from the lunate to the capitate across the stretched mid-carpal capsule, and ensures better correction of the DISI deformity and good range of motion.
A cohort of 8 AFL level footballers was treated with this reconstruction, and retrospectively reviewed.
The modified Brunelli reconstruction was used in all cases. Interestingly, 3 of the 8 cases were delayed by over 12 months, and had already suffered loss of cartilage over the scaphoid proximal pole dorsally. The same operation was performed despite this relative contra-indication. This was protected by a specific translation manouvre to lift the dorsal scaphoid away from the dorsal ridge of the radius whilst the wires holding the reduction were in situ.
All players returned to professional level Australian Rules Football. Follow up examination revealed excellent maintenance of dorsiflexion and good retention of palmar flexion post reconstruction. No players complained of arthritic pain, and no further procedures were performed.
This procedure is an excellent alternative to partial carpal fusion which is promoted in the literature as the only reliable treatment option for symptomatic scapho-lunate instability.
The abstracts were prepared by David AF Morgan. Correspondence should be addressed to him at davidafmorgan@aoa.org.au
Declaration of interest: a
