Prise en charge chirurgicale à ciel ouvert de l’instabilité luno-triquétrale

Abstract

Lunotriquetral dissociation is associated with triangular complex lesions; diagnosis is clinically suggested by pain accentuated by the ulnar deviation and confirmed by arthrography or MRI. Treatment is based on arthroscopic suturing techniques or ligamentoplastic procedures for irreparable damages. Ligamentoplasty using the extensor carpi ulnaris transplant is a simple and attractive technique for the treatment of these instabilities. We report the case of a 40-year old left handed, banking professional. He was victim of a traffic accident causing shoulder and left wrist trauma. Lesions assessment showed shoulder fracture-dislocation treated orthopaedically , associated with a sprained left wrist. Patient underwent an MRI of the wrist that showed triangular ligament lesion. After a dorso-ulnar approach, centered over the radio-ulnar distal joint , and exposure of the lunotriquetral line space, the rupture was confirmed; then, the patient underwent intra-carpien avivement and installation of two Mitek® mini implants; the 3rd operative time consisted of a sample of transplant tendon transfer at the expense of the ulnar extensor carpi left pedicle distally; and finally, the tendon was attached to the lunate and triquetrum bones. Three lunotriquetral pins were fixed to protect ligamentoplasty and removed two months later. Clinical and radiological outcomes were good at six months.

The Pan African Medical Journal 2016;24