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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 11, 1512-1515.
doi: 10.1302/0301-620X.87B11.16361  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Tenodesis of the extensor carpi ulnaris for chronic, post-traumatic lunotriquetral instability

S. A. Shahane, MS(Orth), MCh(Orth), FRCS(Orth), Consultant Orthopaedic Surgeon1; I. A. Trail, MD, FRCS, Consultant Orthopaedic Surgeon1; V. J. Takwale, MS(Orth), FRCS(Orth), Fellow2; J. H. Stilwell, BSc, FRCS, Consultant Orthopaedic Surgeon1; and J. K. Stanley, MCh(Orth), FRCS, FRCSE, Professor and Consultant Orthopaedic Surgeon1

1 Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
2 Gloucester Royal Hospital, Gloucester, Gloucestershire GL51 3NN, UK.

Correspondence should be sent to Professor J. K. Stanley; e-mail: profstanley{at}btinternet.com

We describe a technique of soft-tissue reconstruction which is effective for the treatment of chronic lunotriquetral instability. Part of extensor carpi ulnaris is harvested with its distal attachment preserved. It is passed through two drill holes in the triquetrum and sutured to itself. This stabilises the ulnar side of the wrist.

We have reviewed 46 patients who underwent this procedure for post-traumatic lunotriquetral instability with clinical signs suggestive of ulnar-sided carpal instability. Standard radiographs were normal. All patients had pre-operative arthroscopy of the wrist at which dynamic lunotriquetral instability was demonstrated. A clinical rating system for the wrist by the Mayo clinic was used to measure the outcome. In 19 patients the result was excellent, in ten good, in 11 satisfactory and in six poor. On questioning, 40 (87%) patients said that surgery had substantially improved the condition and that they would recommend the operation. However, six (13%) were unhappy with the outcome and would not undergo the procedure again for a similar problem. There were six complications, five of which related to pisotriquetral problems. The mean follow-up was 39.1 months (6 to 100). We believe that tenodesis of extensor carpi ulnaris is a very satisfactory procedure for isolated, chronic post-traumatic lunotriquetral instability in selected patients. In those with associated pathology, the symptoms were improved, but the results were less predictable.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General