tailieunhanh - Hand and Wrist Surgery - part 8

Tham khảo tài liệu 'hand and wrist surgery - part 8', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | I WRIST INSTABILITY AND ARTHROSCOPY often detached from the dorsal aspect of the lunate. The proximal wrist and mid-carpal joints are examined through the capsular incisions for any osteochondral or chondral lesions. Any free fragments are excised. A trial reduction of the scapholu-nate joint is performed manually and if there is any difficulty in obtaining the reduction Kirschner wires K wires can be placed dorsally in the scaphoid and in the lunate and used as joysticks to assist in the reduction. While maintaining the scapholunate reduction K wires are used to percutaneously pin the scapholunate joint both from the radial and from the ulnar sides to maintain the reduction. Once the scapholunate joint has been pinned radiographs are obtained to confirm the reduction in both AP and lateral projections. Once the reduction has been confirmed radiographically a or suture anchor is placed in the dorsal rim of the proximal half of the scaphoid in the area where the dorsal segment of the scapholunate interosseous ligament and the DIC ligament have been avulsed. Another suture anchor is placed at the dorsal aspect of the lunate if the DIC ligament has been avulsed off the lunate Fig. 63 2A . The suture attached to the scaphoid suture anchor is utilized to reattach the dSLIL and the DIC to their origin on the scaphoid. The suture attached to the lunate suture anchor is utilized to reattach the DIC to its origin on the lunate. If the injury is chronic and the DIC has contracted and lies distal to its normal location then the DIC is released distally while maintaining its triquetral attachment and is relocated and attached to the lunate and scaphoid. Once these sutures are tied the same sutures are used to repair the capsular incision with a slight vest-over-pants imbrication Fig. 63-2B . Reattachment of the proximal membranous portion of the scapholunate interosseous ligament has also been described. This portion of the .