Abstract
Perilunate instability presents a challenge to the hand surgeon, and fraught with complications if untreated. All perilunate dislocations warrant surgical intervention. It occurs through lesser or greater arc disruption, associated with circumferential ligamentous disruption about the lunate, or in conjunction with osseous injuries as a trans-scaphoid perilunate fracture–dislocation or carpal fracture(s) (Malović et al. Mil Med. 176(9):1077–82,2011; Wolfe et al. Green’s operative hand surgery. Philadelphia: Elsevier; 2016. p. 2060; Jones et al. J Hand Surg Am. 37(10):2168–73, 2012). It is not uncommon for perilunate injury to be missed at initial presentation secondary to distracting injuries (Geissler. J Wrist Surg. 2(2):129–35, 2013; Stanbury and Elfar. J Am Acad Orthop Surg. 19(9):554–62, 2011). Perilunate instability can be characterized as acute or chronic (Wolfe et al. Green’s operative hand surgery. Philadelphia: Elsevier; 2016. p. 2060; Stanbury and Elfar. J Am Acad Orthop Surg. 19(9):554–62, 2011). Surgical intervention differs based on chronicity. Traditional management includes temporary Kirschner wire fixation with dorsal scapholunate ligament reconstruction, proximal row carpectomy, reduction and association of the scaphoid and lunate, scapholunate intercarpal screw (Acumed LLC, Beaverton, OR), and different types of arthrodesis/capsulodesis procedures (Wolfe et al. Green’s operative hand surgery. Philadelphia: Elsevier; 2016. p. 2060). A novel technique is recently developed; scapholunate ligament repair with internal bracing shows promising results for future management of perilunate instability (Park et al. J Hand Surg Am. 45(10):985, 2020; Kakar and Greene. J Wrist Surg. 7(4):336–40, 2018).
There have been procedures described to address acute and chronic scapholunate instabilities. Injuries to the scapholunate interosseous ligament have shown a wide spectrum of injury to the ligament. The Geissler “sling and cinch” is a potential repair in acute Geissler grade III and IV injuries as well as for chronic scapholunate instability without degenerative change.
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Geissler, W.B., Purcell, K.F. (2022). Geissler “Sling and Cinch” for Carpal Instability. In: Geissler, W.B. (eds) Wrist and Elbow Arthroscopy with Selected Open Procedures. Springer, Cham. https://doi.org/10.1007/978-3-030-78881-0_17
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