Modified Brunelli procedure : Scapho-lunate ligament reconstruction for wrist instability using Biotenodesis screw(Arthrex)
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This is a detailed step by step instruction through a Modified Brunelli reconstruction of the scapho-lunate interosseous ligament (SLIL) also know as the 3 ligament tenodesis.
The operation is performed to restore carpal mechanics following a SLIL injury and often subsequent attrition of the secondary stabilisers leading to a dorsal-intercalated segment instability (DISI). SLIL injuries over 4-6 weeks old are often very difficult to repair primarily and may require reconstruction if symptoms persist. If the wrist remains symptomatic despite appropriate rehabilitation, splintage and analgesia therapy, surgery may be required.
This can be the case in Geissler grade 3 or 4 ligament tears seen arthroscopically and may also be the operation of choice in grade 1 scapho-lunate advanced collapse (SLAC) in conjunction with a radial styloidectomy.
The operation uses a third to a half of the flexor carpi radialis (FCR) tendon which is passed through the scaphoid, across the dorsal lunate and around the dorso-radiocarpal ligament (DRC). This aims to reconstruct the volar secondary stabiliser of the scapho-trapezial-trapizoid ligament (STT), the dorsal limb of the SLIL and tighten the secondary stabiliser of the DRC. The operation is performed as a daycase procedure and the patient is placed in cast for 4-6 weeks following the procedure to start focussed rehabilitation once casting is complete.
Patients often return to light work at 8 weeks, heavy work at 3 months and continue to strength and improve up to a year post-operation.
Author: Mr Mark Brewster FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham ,UK.
Author:Mr Mark Brewster FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.
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Question 1 of 15
Which ONE answer describes the strongest part of the Scaphoid-lunate ligament?CorrectIncorrect
Question 2 of 15
Which ONE answer describe the role of the scapho-lunate ligament?CorrectIncorrect
Question 3 of 15
Which one answer describes the cause of the ‘clunk’ in a positive Kirk Watson shift test?CorrectIncorrect
Question 4 of 15
Which ONE option describes the radiographic signs of a scapho-lunate ligament rupture?CorrectIncorrect
Question 5 of 15
Which ONE treatment option is most suitable for an incidental finding of a complete scaphoid-lunate ruptureCorrectIncorrect
Question 6 of 15
Which ONE answer describes the ligament which is not reconstructed or tightened by this technique?CorrectIncorrect
Question 7 of 15
Which ONE answer describes where the posterior interosseous nerve lies?CorrectIncorrect
Question 8 of 15
In this minimal approach, which ONE answer best describes the dorsal ligament split in line with its fibres to access the joint?CorrectIncorrect
Question 9 of 15
Which ONE answer best describes the tendon harvested for this procedure?CorrectIncorrect
Question 10 of 15
Which ONE answer best describes the length of tendon harvested in this procedure?CorrectIncorrect
Question 11 of 15
Which ONE answer best describes the volar placement of the bone tunnel in the scaphoid?CorrectIncorrect
Question 12 of 15
Which ONE answer best describes the size of the cannulated drill to best allow the graft and interference screw to be inserted?CorrectIncorrect
Question 13 of 15
Which ONE answer best describes the duration of casting for this procedure?CorrectIncorrect
Question 14 of 15
Which ONE answer best describes the % of patients with mild or no pain when recovered from this procedure according to Talwakar et al?CorrectIncorrect
Question 15 of 15
Which ONE answer best describes the % loss of flexion in patients when recovered from this procedure according to Talwakar et al?CorrectIncorrect