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The Brunelli’s Tenodesis

  • F. Schuind
  • W. El Kazzi
Chapter

Abstract

Of the many patterns of wrist osteoarthrosis, the SLAC wrist (scapholunate advanced collapse pattern) is one of the commonest. The main cause of osteoarthrosis is the pathological palmar flexion and dorsal subluxation of the scaphoid. The main cause of osteoarthrosis is the pathological to a decrease in the joint contacts between the scaphoid and the radius. The resulting excessive articular stresses cause the osteoarthrosis, first involving the radioscaphoid joint. The lunate dorsal flexion seems to have little consequences at the level of the radiolunate joint. The principal objective of the treatment is therefore to correct the malposition of the scaphoid, before the occurrence of chondral degeneration. This can be achieved by the technique of Brunelli, where a band of the Flexor carpi radialis tendon, still attached to the base of the second metacarpal, is tunnelled through the distal pole of the scaphoid and anchored to the dorso-ulnar radius. The method is described and the results discussed. The original technique of Brunelli seems to achieve better reduction of the scaphoid than the derived techniques, including the three-ligament tenodesis (3LT).

Keywords

Distal Radius Fracture Flexor Carpus Radialis Distal Pole Proximal Pole Extensor Pollicis Longus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Berger RA (2007) A method of defining palpable landmarks for the ligament-splitting dorsal wrist capsulotomy. J Hand Surg Am 32:1291–1295PubMedCrossRefGoogle Scholar
  2. 2.
    Brunelli GA, Brunelli GR (1995) Une nouvelle intervention pour la dissociation scapho-lunaire. Proposition d’une nouvelle technique chirurgicale pour l”instabilité carpienne avec dissociation scapho-lunaire (11 cas). Ann Chir Main 14:207–213Google Scholar
  3. 3.
    Brunelli GA, Brunelli GR (1995) A new technique to correct carpal instability with scaphoid rotary subluxation: a preliminary report. J Hand Surg Am 20(3 Pt 2):S82–S85PubMedCrossRefGoogle Scholar
  4. 4.
    Chabas JF, Gay A, Valenti D, Guinard D, Legre R (2008) Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients. J Hand Surg Am 33:1469–1477PubMedCrossRefGoogle Scholar
  5. 5.
    de Smet L, van Hoonacker P (2007) Treatment of chronic static scapholunate dissociation with the modified Brunelli technique: preliminary results. Acta Orthop Belg 73:188–191PubMedGoogle Scholar
  6. 6.
    dos Reis FB, Koeberle G, Leite NM, Katchburian MV (1993) Internal fixation of scaphoid injuries using the Herbert screw through a dorsal approach. J Hand Surg Am 18:792–797PubMedCrossRefGoogle Scholar
  7. 7.
    Garcia-Elias M (1997) The treatment of wrist instability. J Bone Joint Surg Br 79:684–690PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia-Elias M, Lluch AL, Stanley JK (2006) Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 31:125–134PubMedCrossRefGoogle Scholar
  9. 9.
    Hagert E, Persson JK, Werner M, Ljung BO (2009) Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. J Hand Surg Am 34(4):642–651PubMedCrossRefGoogle Scholar
  10. 10.
    Howlett JP, Pfaeffle HJ, Waitayawinyu T, Trumble TE (2008) Distal tunnel placement improves scaphoid flexion with the Brunelli tenodesis procedure for scapholunate dissociation. J Hand Surg Am 33:1756–1764PubMedCrossRefGoogle Scholar
  11. 11.
    Kuo CE, Wolfe SW (2008) Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 33:998–1013PubMedCrossRefGoogle Scholar
  12. 12.
    Links AC, Chin SH, Waitayawinyu T, Trumble TE (2008) Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg Am 33:850–856PubMedCrossRefGoogle Scholar
  13. 13.
    Schuind F (1995) Scapholunate reconstruction using a vascularized flap of the interosseous membrane. J Orthop Surg Tech 9:21–26Google Scholar
  14. 14.
    Schuind F, Fumière E, Sintzoff S (1996) The value of standard and functional radiographs in diagnosing wrist instability. In: Büchler U (ed) Wrist instability. Martin Dunitz, London, pp 61–67Google Scholar
  15. 15.
    Schuind F, Alemzadeh S, Dhaene F, Feipel V (1997) New technique: reconstruction of the scapholunate ligament using a vascularized flap of the interosseous membrane. In: Saffar P, Amadio PC, Foucher G (eds) Current practice in hand surgery. Martin Dunitz, London, pp 299–305Google Scholar
  16. 16.
    Short WH, Werner FW, Green JK, Masaoka S (2005) Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part II. J Hand Surg Am 30:24–34PubMedCrossRefGoogle Scholar
  17. 17.
    Short WH, Werner FW, Green JK, Sutton LG, Brutus JP (2007) Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 32:297–309PubMedCrossRefGoogle Scholar
  18. 18.
    Talwalkar SC, Edwards AT, Hayton MJ, Stilwell JH, Trail IA, Stanley JK (2006) Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability. J Hand Surg Br 31:110–117PubMedCrossRefGoogle Scholar
  19. 19.
    van den Abbeele KL, Loh YC, Stanley JK, Trail IA (1998) Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg Br 23:258–261CrossRefGoogle Scholar
  20. 20.
    Watson HK, Ballet FL (1984) The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 9:358–365PubMedGoogle Scholar
  21. 21.
    Werner FW, Short WH, Green JK, Evans PJ, Walker JA (2007) Severity of scapholunate instability is related to joint anatomy and congruency. J Hand Surg Am 32:55–60PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyErasme University HospitalBrusselsBelgium

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