Extensor carpi radialis brevis ligamentoplasty and dorsal capsulodesis for the treatment of chronic post-traumatic scapholunate instability.

OBJECTIVES: To present a novel surgical technique that includes both extensor carpi radialis brevis (ECRB) ligamentoplasty and dorsal capsulodesis for the treatment of chronic post-traumatic scapholunate instability. METHODS: We performed a retrospective review of 32 patients with chronic post-traumatic scapholunate instability (stage 4 or 5 according the Garcia-Elias' classification) who were treated with this technique. Pre- or intraoperative arthroscopic evaluation was carried out in all cases. RESULTS: The postoperative wrist range of motion was generally improved except for wrist flexion. In 20 patients out of 29, the DISI deformity was corrected. Grip strength and pain was also improved postoperatively. Based on the Mayo wrist scoring, 16 patients had excellent results, eight patients had good results, three patients had fair results, and five patients had poor results. CONCLUSION: Our technique which combines ECRB ligamentoplasty with dorsal capsulodesis is a reliable option for the surgical treatment of chronic postchronic post-traumatic scapholunate instability.

Normal range-of-motion of trapeziometacarpal joint.

PURPOSE: The range-of-motion of the trapeziometacarpal joint is difficult to assess clinically. The purpose of our study was to constitute a range-of-motion database from normal active trapeziometacarpal joints. MATERIAL AND METHODS: Two hundred hands from 101 healthy subjects (50 female and 51 male) with a mean age of 23.1 years (range: 22 to 35 years) have been evaluated. An optoelectronic device (Polaris) was used to analyse the thumbs range-of-motion. Splints were fitted so as to isolate the trapeziometacarpal joint and retroreflective markers were placed both on the splints and on the thumb. After active flexion-extension, abduction-adduction, axial rotation and circumduction, the different range-of-motion parameters were calculated. RESULTS: The mean range-of-motion of the trapeziometacarpal joint was 41 degrees for flexion-extension, 51 degrees for abduction-adduction and 21 degrees for axial rotation. Comparisons between female and male subjects showed significant differences concerning flexion-extension, abduction-adduction axial rotation and circumduction. No significant differences were noted between right and left hands except for the abduction-adduction movement. DISCUSSION AND CONCLUSION: One hundred and one healthy subjects were analysed for the development of a database of normal active range-of-motion parameters of the trapeziometacarpal joint, with an in vivo protocol. This database should allow comparing the range-of-motion of patients with osteoarthritic trapeziometacarpal joint and assessing surgical outcome.