SURGICAL MANAGEMENT OF MID-CARPAL INSTABILITY USING SUTURE ANCHORS

Abstract

Ligamentous injuries to the wrist are less common than osseous injuries and most of them are left neglected.16 year old was evaluated for chronic wrist pain, clunk and weakness in hand grip of the right wrist of 6 months duration with malunited forearm fracture following native treatment. Volar displacement stress test showed subluxation of mid-carpal joint which was appreciable on ulnar deviation of wrist joint with positive clunk. stress X-rays showed aVISI pattern with normal MRI. Peroperatively the instability was found to be at the dorsal aspect of Capitolunate joint,the Capitate subluxing Volarwards,taking the lunate towards Volar aspect.To stabilize Capitolunate joint,Suture anchor was inserted from the dorsal aspect of the Capitate. 2-0 prolene suture material was looped through the suture anchor in the capitate and Osseous suture was taken from the dorsal bony periosteal rim of the lunate and tied together. The torn ligamentous remnants of the radiocapitate ligament were repaired and the suture to act as a scaffold. Intra-operatively stability was confirmed and showed no clunking or volar  instability. Immediate post-operative period was uneventful. Follow up at 3,6,12,18,24 months showed normal asymptomatic and stable wrist and no clunking.Post-op Xrays showed normal Capitolunate and Scapholunate angles.We are presenting this case as there is little published evidence of capitolunate instability which is managed by low cost CUSTOM MADE SUTURE ANCHORS.