Lunotriquetral ligament repair
1. General considerations
A lunotriquetral ligament rupture should be reduced and repaired, eg, with suture anchors and temporary K-wire joint transfixation.
2. Reduction
At the subsequent surgery, insert a joystick K-wire into each the lunate and the triquetrum.
Reduce the lunotriquetral joint with the K-wires to close the gap.
Pointed reduction forceps may be used to hold the reduction.
3. Ligament repair
Principles
In most cases, the lunotriquetral ligament is torn from the lunate.
Usually, reduction and temporary fixation of the lunotriquetral relationship is all that is possible from the dorsal aspect.
K-wire transfixation
Reduce the lunotriquetral relationship and insert two 1.4 mm K-wires percutaneously from the triquetrum into the lunate.
Confirm the reduction using image intensification.
Ligament repair
If there is sufficient ligament remnant, repair with a bone anchor is possible. Insert a suture anchor into the debrided area of the avulsion.
If there is a larger bony avulsion of the lunotriquetral ligament from either bone, the fragment can be fixed with fine K-wires or a small screw.
After final confirmation of accuracy of realignment, using image intensification, cut and bend over the K-wires, so that they do not protrude through the skin.
