Revisiting Lunotriquetral Arthrodesis in Chronic Lunotriquetral Ligamentous Injuries

Abstract

Background Chronic lunotriquetral (LT) ligament tears are a source of ulnar-sided wrist pain. Left untreated, complete tears of the LT ligament may progress to a volar intercalated segment instability deformity and eventual carpal arthritis. Various treatments have been proposed, one of which is LT arthrodesis. LT arthrodesis has been criticized for high rates of nonunion frequently requiring reoperation, and therefore has largely fallen out of favor. However, our experience has been quite different from the literature. This study examines a single surgeon's experience with LT arthrodesis over a 15-year period. Methods A retrospective review of the senior author's practice over a 15-year period was performed. All adult cases of LT arthrodesis for chronic LT injuries were included. Headless compression screw and cancellous bone graft from the distal radius were used for primary arthrodesis in all cases. The primary outcome was rate of union, and secondary outcomes were time to union, secondary or salvage procedures, and range of motion. Nonparametric statistical analysis was used to calculate differences in outcomes. Results Twenty-eight patients met inclusion criteria. The median age was 45.5 (interquartile range [IQR] 35-50) years and 75% were male. The dominant hand was most commonly affected. Eighty-six percent of patients achieved union, one patient required redo arthrodesis, and one patient went on to wrist salvage. Three patients developed a pain-free pseudoarthrosis. Median time to radiographic union was 8.8 (IQR 5.9-11.9) weeks. Conclusion Despite multiple previous reports, this study demonstrates that LT arthrodesis for chronic LT injuries is a safe technique with high rates of successful union. Further comparative studies are warranted to determine the optimal treatment for chronic LT injuries.

Keywords: arthrodesis; carpal arthritis; lunotriquetral ligament.

Fig. 1

Pre- ( A – C ) and postoperative ( D – F ) radiographs of a patient who underwent lunotriquetral (LT) arthrodesis for chronic LT injury.

Fig. 2

Preoperative ( A – C ) radiographs demonstrate mild widening of the lunotriquetral (LT) interval, but normal carpal angles. Intraoperative fluoroscopy ( D , E ) demonstrates Kirschner wire (K-wire) placement and subsequent cannulated screw position with anatomic alignment of the carpus. Postoperative radiographs ( F – H ) demonstrate union across the LT interval and evidence of distal radius bone graft harvest site.