From the above xrays the patient has a grade 3A Litchman lunatomalacia.
AP shows a flexed scaphoid ( ring sign) with the carpal ratio altered suggesting lunate foreshortening.
Radial styloid appears sharp - radial styloid OA.
clenched fist AP ( Why)does not show a flexed scaphoid.( cannot explain). is it a correctable scaphoid flexion
Definite ulnar minus
What would you do?
1. joint levelling procedure ie; radail shortening
2. radial styloidectomy and Scapholunate fusion to unload the lunate with or without lunate excision
3. STT fusion
4. revascularisation with interacarpal vessel
my suggestion would be to scope to see if radioscaphoid (styloid OA is present) if present my choice would be no 2. if not 1.
Any valid advise is welcome for the friend who asked for my opinion
