月骨脱位手术图解.pptVIP

* LUNATE AP and lateral radiograph of a transscaphoid perilunate dislocation. The lunate is facing directly volar and is located in the carpal canal. LUNATE CAPITATE After attempt at closed reduction in the emergency room, the patient’s lunate was repositioned against the distal radius, however the midcarpus is still dislocated as the capitate remains dorsal to the capitate fossa of the lunate. LUNATE CAPITATE The patient’s neurologic status was intact, with normal peripheral nerve sensation, including 2 point discrimination. EPL LISTER’S TUBERCLE INCISION Dorsal view of the wrist showing the extensor pollicus longus (EPL) tendon. The EPL tendon passes ulnarward of Lister’s tubercle before angling toward the thumb. The incision is based as seen (between the third and fourth dorsal compartment). EXTENSOR RETINACULUM The incision is brought down through the soft tissue and the extensor retinaculum is identified. EPL 2nd DORSAL COMPARTMENT After the release of the extensor retinaculum between the third and fourth dorsal compartments, the extensor pollicus longus and second dorsal compartment tendons are visualized. The EPL and second compartment are retracted radially, while the common extensor tendons are retracted laterally, exposed the wrist capsule. LUNATE CAPITATE SCAPHOID (PROXIMAL FRAGMENT) SCAPHOID (DISTAL FRAGMENT) After the capsule is incised, the carpal bones are visualized. The lunate is visualized adjacent to the distal radius. The capitate is seen dorsally dislocated from the lunate. EPL SCAPHOID (PROXIMAL FRAGMENT) SCAPHOID (DISTAL FRAGMENT) Using a Freer elevator, luno-capitate joint is reduced. The capitate is now within the confines of the lunate. The lunate and proximal scaphoid are in their normal relationship as this interval is not interrupted. The scaphoid fracture is visualized adjacent to the capitate. LUNATE CAPITATE SCAPHOID SCAPHOID FRACTURE As visualized from distally, looking down at the articular surface of the scaphoid that ar