Brunelli procedure

Brunelli Procedure or Brunelli's Procedure is a surgical technique used in the treatment of Scapholunate Dissociation, a condition characterized by the disruption or tearing of the scapholunate ligament in the wrist. This ligament is crucial for the proper movement and stability of the wrist joint. The procedure aims to restore stability to the wrist, alleviate pain, and prevent the onset of arthritis that can result from the instability.

Overview

The Brunelli Procedure involves the use of a tendon graft to reconstruct the damaged scapholunate ligament. The graft is typically harvested from the Flexor Carpi Radialis (FCR) tendon, which is then passed through a drilled hole in the scaphoid and lunate bones to mimic the action of the original ligament. This technique not only stabilizes the scapholunate joint but also preserves wrist motion to a significant extent.

Indications

The Brunelli Procedure is indicated for patients with symptomatic scapholunate dissociation, especially those who have failed conservative treatment measures such as splinting, physical therapy, and anti-inflammatory medications. It is also considered in cases where early degenerative changes have begun to set in but have not yet progressed to advanced stages.

Surgical Technique

The surgery is performed under general anesthesia or regional block. A dorsal incision is made over the wrist to expose the scapholunate interval. After the FCR tendon is harvested, it is prepared as a graft. A hole is drilled through the scaphoid and lunate bones, and the tendon graft is passed through these holes in a specific manner designed to replicate the function of the original scapholunate ligament. The ends of the graft are then secured, stabilizing the joint.

Postoperative Care

Postoperative care involves immobilization of the wrist in a splint or cast for a period of 6 to 8 weeks to allow for healing. This is followed by a structured rehabilitation program focusing on regaining wrist motion and strength. Full recovery and return to normal activities can take several months.

Complications

As with any surgical procedure, the Brunelli Procedure carries risks such as infection, nerve damage, and stiffness. There is also the possibility that the surgery may not fully restore wrist stability or function, and in some cases, additional surgery may be required.

Outcomes

Studies have shown that the Brunelli Procedure can be effective in improving wrist stability and reducing pain in patients with scapholunate dissociation. However, outcomes can vary based on the extent of the injury, the patient's age, and the presence of any pre-existing degenerative changes in the wrist.

See Also

• Wrist Anatomy
• Ligament Reconstruction
• Hand Surgery