Load transfer characteristics of the wrist. Part II. Perilunate instability

Ulnar-sided perilunate instability: an anatomic and biomechanic study

A staging system for ulnar-sided perilunate instability is presented based on a series of cadaver dissections and load studies. Stage I: partial or complete disruption of the lunotriquetral interosseous ligament, without clinical and/or radiographic evidence of dynamic or static volar intercalated segment instability deformity; stage II: complete disruption of the lunotriquetral interosseous ligament and disruption of the palmar lunotriquetral ligament, with clinical and/or radiographic evidence of dynamic volar intercalated segment instability deformity; and stage III: complete disruption of the lunotriquetral interosseous and the palmar lunotriquetral ligaments, attenuation or disruption of the dorsal radiocarpal ligament, with clinical and/or radiographic evidence of static volar intercalated segment instability deformity.

Evaluation of the biomechanical efficacy of limited intercarpal fusions for the treatment of scapho-lunate dissociation

An experimental model that uses a static positioning frame, pressure-sensitive film, and a microcomputer-based videodigitizing system was used to measure the contact areas and pressures in a group of wrists in their "normal" state, after ligament sectioning, which resulted in stage III perilunate instability and then following different types of simulated carpal fusions. Compared with a normal wrist, there is an overall decrease in load in the lunate fossa and a significant increase in load in the scaphoid fossa in the wrist with stage III perilunate instability. Scaphoid-trapezium-trapezoid and scaphoid-capitate fusions transmitted almost all load through the scaphoid fossa. Scaphoid-lunate, scaphoid-lunate-capitate, and capitate-lunate fusions all distributed load more proportionately through both scaphoid and lunate fossae. The positioning of the carpal bones within a limited carpal fusion was also found to affect the load distribution in the wrist. The scaphoid-lunate, scaphoid-lunate-capitate, or capitate-lunate fusions, with attention to the relative carpal alignment within the limited fusion seem to offer more promise for treatment of perilunate instability biomechanically than the scaphoid-trapezium-trapezoid or scaphoid-capitate fusions.

Radiocarpal articular contact characteristics with scaphoid instability

The relative importance of the three major periscaphoid ligament complexes in maintaining the normal radiocarpal articulation was assessed. Pressure-sensitive film recorded the changes in radioscaphoid and radiolunate articular contact that occurred with sequential ligament sectioning in 12 cadaver wrists. Alterations in the radiocarpal articular contact as a result of ligament disruption are evident in the absence of the recognizable static x-ray changes of carpal instability. The scapholunate interosseous ligament is essential in preventing scapholunate diastasis and dorsoradial subluxation of the proximal scaphoid. Rotatory subluxation of the scaphoid occurs when disruption of the scapholunate interosseous ligament is coupled with disruption of either the palmar intracapsular radiocarpal ligaments or the scaphotrapezial ligament complex. These data help explain the development of degenerative arthritis caused by carpal ligamentous instability.

The effects of various load paths and different loads on the load transfer characteristics of the wrist

An experimental model that incorporated a static positioning frame, pressure-sensitive film, and a microcomputer-based videodigitizing system was used to analyze the effects of different loading pathways and various loads on the contact area and pressures within the wrist joint. There was no statistically significant difference in loading the wrist with comparable weights through the second and third metacarpals, through all five metacarpals, or through weights suspended from the wrist flexor and extensor tendons. A nonlinear relation was discovered between increasing loads and greater overall contact areas. The general distribution of the contact between the scaphoid and the lunate contact areas was consistent at all of the loads tested with 60% of the total contact area involving the scaphoid contact area and 40% involving the lunate contact area. Loads greater than 46 pounds were not found to significantly increase the overall contact areas implying that the cartilage of the wrist joint was maximally compressed at loads of this magnitude. At loads higher than 46 pounds it appears that average high pressures increase in a more direct correlation with the increase in weight. The overall contact area even at the highest loads tested were not more than 40% of the available joint surface. The contact areas were not concentric or symmetric as is characteristic of the incongruance of the radio/triangularfibrocartilage (ulna)/carpal joint.