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Analysis of Predynamic and Dynamic Proximal Carpal Row Injuries
Eric Wagner, MD; Robert R. Gray, MD; Sanjeev Kakar, MD
Mayo Clinic, Rochester , MN

Purpose: Currently, there is limited information regarding the clinical outcomes following percutaneous pinning of proximal carpal row injuries. The purpose of this study is to percutaneous pinning and capsulodesis of dynamic or predynamic proximal carpal instability versus pinning alone.

Methods: We reviewed the charts of all patients who underwent surgery at our institution from 1998-2008 for carpal instability. Patients with predynamic or dynamic scapholunate or lunotriquetral ligament injury who were treated with percutaneous pinning alone or in conjunction with dorsal capsulodesis were identified. We excluded high-energy mechanisms, such as perilunate lesser arc or fracture-dislocations, as well as all tenodesis or screw-association procedures. Patientsí charts were evaluated using the following criteria: acute (< 6 weeks), chronic (>6 weeks) duration of injury, presence of distal radius fracture, debridement of intercarpal interval, use of thermal ligament shrinkage, and progression to a reconstructive or salvage procedure. Pre-and postoperative radiographs were evaluated for scapholunate diastasis, radioscaphoid, and scapholunate angles. Pre- and postoperative Mayo Wrist Scores (MWS) and Visual Analog Scale (VAS) were obtained.

Results: 62 patients with dynamic and predynamic injuries were identified with an average followup of 23.6 months. Postoperative immobilization averaged 6.6 weeks.  27 patients were treated acutely with percutaneous pinning of the proximal row with or without open ligament repair and had pre- and postoperative VAS and MWS of 5.5 and 58.9; and 1.8 and 72.3, respectively. 35 patients treated at greater than 6 weeks had pre- and postoperative VAS and MWS of 4.5 and 67.3; and 2.4 and 70.7, respectively. 

The 38 patients treated with pinning alone had a pre- and postoperative MWS of 64.7 and 71.3 and the 24 treated with pinning and capsulodesis had pre-and postoperative MWS of 59.2 and 69.6. The patients treated with pinning alone for an acute injury had pre- and postoperative MWS of  58.9 and 63.3, while those treated for a chronic injury had MWS of 67.3 to 70.7.

Patients with concomitant distal radius fracture 12 (19%) had significantly higher MWS (81.3, p=0.04), than those without (68.4). The average pre- and postoperative scapholunate intervals measured 1.9mm and 2.1mm for all patients. The average pre- and postoperative scapholunate angles were 58.6 and 62.5 degrees, respectively.

Conclusions: These results suggest that percutaneous pinning of dynamic and predynamic proximal carpal row injuries does not significantly improve clinical outcomes, except in the case of concomitant distal radius fracture.  Neither injury acuity nor addition of open capsulodesis significantly improves results.

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