this is Nicole deal in this video will
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demonstrate our technique for
00:06
scapholunate
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ligament reconstruction using a
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proximately based capsular flap as well
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as portion of the dorsal and acropole
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event a midline incision is made
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centered directly over the center of the
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wrist and care is taken to preserve any
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cutaneous nerves and immaculate
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hemostasis is achieved as we approach
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the extensor retinaculum here you can
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see the extensor retinaculum has been
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exposed we will open the extensor
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retinaculum in a step step cut fashion
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to allow Rhea proximation at the
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completion of the case at this portion
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of the procedure the extensor tendons
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are directly beneath the extensor
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retinaculum and particularly vulnerable
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as extensor pollicis longus so care must
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be taken to dissect the extensor
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retinaculum free from the tendons
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without entering the tendons
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here the extensor retinaculum has been
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open and we're demonstrating the fourth
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extensor compartment AG LP is placed
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between the fourth and the second
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extensor compartments and EPL has also
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been reflected radially we were just
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indicating the poster and rosiest nerve
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and the wrist is ranged to determine the
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appropriate area to base our flap here a
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proximally based flap of capsular tissue
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is raised which will later be attached
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to the scaphoid as a tether using a
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suture anchor here we're continuing to
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elevate our flap
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and you can see exposed to the carpals
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beneath here wires are being driven into
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the scaphoid and into the lunate to use
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as joysticks for positioning the bones
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for fixation this is demonstrating the
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maneuver utilized to hold the scaphoid
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and the lunate in a reduced position you
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can see here on the fluoroscopy that the
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alignment has been reconstructed as a
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pin is placed from the scaphoid into the
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capitate and from the scaphoid into the
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lunate to maintain this alignment and an
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additional pin is placed from the
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scaphoid into the lunate at this point
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the residual scapholunate ligament and
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dorsal capsular flap are identified into
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suture anchors placed in the scaphoid to
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allow attachment of these structures
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here we are placing the suture anchor
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and an additional suture anchor is
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placed more distally in the scaphoid
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once these suture anchors are in place
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the residual scaphoid lunate ligament
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and a portion of the dorsal inner carpal
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ligament are attached to the more
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proximal anchor as is done here and then
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the dorsal capsular flap is approximated
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to the more distal anchor and the
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residual scaphoid lunate ligament is
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attached to the more proximal of the
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anchors
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here the capsular flap is being attached
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the posterior osseous nerve is
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identified in the floor of the fourth
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extensor compartment it is responsible
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for sensory function only at the wrist
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and the denervation is performed to
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assist with the patient's pain this is
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the posterior osseous nerve being
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transected here the extensor retinaculum
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is really doe the EPL which is not
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placed under the extensor retinaculum at
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the time of closure
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the incision is irrigated and closed and
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the patient is placed in a sterile
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dressing and in a splint post-operative
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fluoroscopy demonstrates restoration of
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the scaphoid lunate angle and the
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scaphoid lunate interval