HS1: HOW I MANAGE SCAPHOLUNATE DISSOCIATION

Abstract

Introduction: Scapholunate dissociation can occur after trauma or as part of a degenerative process. In the acute situation, it can be a difficult finding to recognise. There is little doubt that the best results of treatment in acute cases are obtained after an early primary repair. However, many patients do not present within a timescale considered optimum for primary repair.

I will discuss a personal approach to managing this condition at each stage of presentation, considering how appropriate each alternative treatment may be, and describing in detail what happens to such patients in my practice.

Diagnosis: This is perhaps the biggest challenge in this condition.

As specialist hand surgeons, we pride ourselves on a diagnostic suspicion whenever we are met with an appropriate history or likely injury mechanism. We are able to assess the patient individually, their plain radiographs, MRI arthrograms and arthroscopic findings. The challenge in providing a service for this injury, is to extend that knowledge (or make it readily accessible) to a wider group of generalists in Orthopaedic Surgery, Trauma Surgery and Emergency Medicine.

I will describe my method of assessment with preferred imaging techniques.

Decision making: Decision making in managing scaph-olunate ligament dissociation is not straightforward. A ‘recipe book’ approach will not provide the best for each individual patient, and management must be tailored to patients, injury types, duration and surgeon’s abilities.

I will illustrate some of the pitfalls in decision making with a series of case examples, and explain my personal approach.

Treatment: Operative treatments fall into 3 categories;

• Acute repair

• Reconstruction

• Salvage

I will describe my preferred techniques, which procedures I no longer perform (and why) and rehabilitation programmes in detail for these categories.