Lunate or perilunate dislocations are common carpal injuries. Current treatment of these injuries by repair or reconstruction of intra-carpal ligaments is largely based on Mayfield's description of sequential failure of these ligaments. We do treat significant number of these injuries. We have observed that dorsal wrist capsule is attached to dorsal aspect of proximal carpal row and its interosseous ligaments by vertically oriented identifiable fibres. This can be seen as carpal bones suspended from dorsal capsule, akin to cloths suspended from a washing line. We have also observed that in lunate or perilunate dislocations, dorsal capsule is peeled off from the dorsal aspect of lunate and distal radius, similar to a Bankart lesion in the shoulder. We believe that dorsal capsule plays a bigger role in the stabilising mechanism of carpal bone than the intercarpal ligaments. It has not been described before. We dissected three cadaveric wrists and found vertical fibres running from dorsal wrist capsule/ligaments to the dorsal components of the scapholunate and lunotriquetralinterosseous ligaments. We have modified the Mayo approach to dorsal wrist capsule and use suture anchors to attach dorsal capsule/ligaments to scaphoid, lunate and triquetrum rather than repairing intra-carpal ligament. We have used this technique in 26 patients so far. Follow up for more than 4 years have shown satisfactory results and no significant recurrence of instability. We present a novel, so far unreported, method of repairing the intracarpal injuries, using the dorsal capsule/ligaments, based on anatomic and intra-operative observations

Aim:. To assess the clinical outcomes of patients that had perilunate or lunate dislocations treated with either open or closed reduction and wiring without repair of the scapholunate interosseous ligament (SLIL). Background:. Current literature states that acute perilunate dislocations should be treated with open reduction and repair of the dorsal scapholunate ligament. This is to prevent dissociative carpal instability and potential long term degenerative arthrosis. Methods:. A retrospective review of patients who sustained a perilunate or lunate dislocation, with no associated radial or carpal fracture was conducted. All were treated by reduction and percutaneous wiring without repair of the SLIL. Patients were examined and data was collected regarding patient's pain, range of motion, grip strength, instability and return to work. All patients had a Mayo wrist score. Pre and post-surgical radiographs were assessed and the scapholunate distance, scapholunate angle and the radiolunate angle were measured. The presence of a high riding scaphoid and osteoarthritis was recorded. Results:. A total of 13 patients were included in the study, with an average follow up of 32 months. 92% of patients had no pain in their wrist at final follow up. Range of movement was 78% of the normal side. 70% of patients returned to work. 92% of patients had no clinical wrist instability. Grip strength was 82% of the opposite side. Radiographic assessment showed an average scapholunate distance of 2.6 mm, a scapholunate angle of 65° and radiolunate angle of 11°. One of the 13 patients had a high riding scaphoid. 23% of patients had arthritic changes of the carpus on plain radiographs. Of the 13 patients, 3 had excellent mayo scores, 4 good, and 6 fair. No patients had poor scores. Of the 13 patients reviewed 10 returned to work, those that did not were not able to due to other disabilities acquired at the time of their accident. Conclusion:. Acute management of perilunate dislocations with reduction and percutaneous wiring without repair of the SLIL, resulted in the majority of patients having a pain free, stable, mobile wrist with an above average Mayo wrist score and no arthritic change on radiographic assessment

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Elective surgery has been severely curtailed as a result of the COVID-19 pandemic. There is little evidence to guide surgeons in assessing what processes should be put in place to restart elective surgery safely in a time of endemic COVID-19 in the community.