The Journal of Bone and Joint Surgery, Vol 68, Issue 8 1164-1176, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Chronic capitolunate instability
RP Johnson and GF Carrera
Twelve patients, twelve to thirty-two years old, were evaluated for
complaints of chronic vague pain, weakness, and clicking in the wrist that
had followed a significant but remote dorsiflexion injury to the wrist.
Although a standard orthopaedic examination and plain roentgenograms of the
carpus were unremarkable, a dorsal-displacement stress test done under
fluoroscopic control with the radius fixed showed dorsal subluxation of the
capitate out of the cup of the lunate, accompanied by a marked feeling of
apprehension by the patient. This was also associated with a painful snap
or click due to a sudden dorsal attitude and ulnar shift of the lunate,
best elicited with the wrist in slight ulnar deviation. We believe that
this condition is due to attenuation of the radiocapitate ligament
resulting from prior trauma. Eleven patients were operated on. The volar
radiocapitate ligament was tightened by tethering its central portion to
the radiotriquetral ligament, partially obliterating the space of Poirier.
Slight extension of the wrist was lost by this procedure, but the capitate
could no longer be passively displaced and the lunate became stable. Using
both objective and subjective criteria, six patients had an excellent
result; three, good; one, fair; and one, poor. There was an average final
loss of 15 degrees of extension and 19 degrees of flexion of the wrist. The
average length of follow-up was four years and four months (range,
twenty-four to 109 months). We concluded that insufficiency of the
radiocapitate ligament after trauma to the wrist is one cause of chronic
symptomatic capitolunate instability. Shortening of the radiocapitate
ligament is recommended to stabilize the lunate and capitate.
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