Catálogo de publicaciones - libros

Symptomatic lunotriquetral interosseous ligament tears have been managed by simple arthroscopic debridement, ligamentous repair, and intercarpal arthrodesis. Ligamentous repair or grafting requires an extensile approach, and lunotriquetral joint fusion limits flexion and extension and radioulnar deviation by 14% and 25%, respectively.^33 Arthroscopic ulnocarpal ligament plication, in addition to LT joint reduction and stabilization, is designed to augment the volar aspect of the LT joint. LT ligament tears are often associated with other pathology, notably ulnarcarpal ligament tears and disruption of the distal radioulnar joint.^34 Furthermore, suture plication of the ulno-carpal ligaments shortens their length to act as a checkrein to excessive lunotriquetral motion perhaps similar to ulnar shortening procedures. Prestyloid recess tightening increases tension in the ulnar DRUJ capsule. In the presented approach for lunotriquetral instability, postoperative improvement in comfort and function is common. Arthroscopy aided in treatment by comprehensive evaluation of the injured structures and, in many cases, treated multiple concurrent injuries. Arthroscopic stabilization of the lunotr iquetral joint is useful for treatment while minimizing motion losses after surgery and surgical exposure.

At first, percutaneous techniques of scaphoid fracture reduction and fixation may appear daunting. However, with experience, they offer a powerful and versatile capability that is demonstrating promising results in the treatment of notoriously difficult fractures and nonunions. Development of small-joint arthroscopic skill is one of the essential steps in mastering this method of scaphoid fracture treatment.

Arthroscopic radial styloidectomy is a useful treatment for symptomatic arthritis localized to the distal radioscaphoid articulation, either as an isolated technique or as an adjunct to another carpal procedure. The procedure is minimally invasive with the potential for temporary pain relief and improved hand function. The details of the technique are important to review in order to avoid injury to cutaneous nerves, the dorsal branch of the radial artery, and the palmar radiocarpal ligaments. The bony resection should be limited to 3 mm to 4 mm, preserving the origins of the radioscaphocapitate and long radiolunate ligaments.

Arthroscopic excision of dorsal ganglia is a reasonable alternative to open excision, with decreased postoperative morbidity. Arthroscopic excision has been shown to equal, if not lower the risk of recurrence, as compared with open excision. This lower risk of recurrence in preliminary studies, combined with more rapid improvement in postoperative range of motion is a significant advantage over open excision. Arthroscopic excision allows precise identification and excision of the stalk of the ganglion from the scapholunate interosseous ligament under magnified conditions. It allows protection of the scapholunate interosseous ligament as it is directly visualized under bright light and in well-magnified conditions. This may potentially lower the risk of injury to the interosseous ligament as compared to open excision.^17 Simultaneous arthroscopic evaluation of the radiocarpal and midcarpal spaces allows detection and management of any additional intra-articular pathology that may be extant. This also allows the patient to trade a bump for a portal rather than a scar, which is pleasing to those patients who feel cosmesis is important.

Arthroscopy of the small joints of the hand has become a reliable clinical tool, although somewhat limited in diagnostic applications. Therapeutic options are becoming increasingly available but must be balanced against the efficacy of open procedures. The arthroscopy of these joints is safe, but only if the relevant anatomy is thoroughly understood by the surgeon.