A, Ligamentous augmentation. Some laxity of scaphotrapezial joint is apparent. Strip of extensor carpi radialis longus can be passed through drill hole that is directed through tuberosity. B, Tendon is pulled through hole and passed into joint capsule over scaphoid waist. C, Tendon is passed through dorsal aspect of lunotriquetral ligament after producing hole with tendon passer. D, This is looped under itself and passed distally into hole in capitate. Scaphoid and lunate are reduced and fixed. Tendon can be pulled taut and sutured to itself. Line of pull tends to depress proximal pole of scaphoid, elevate distal pole correcting rotatory subluxation, and rotate lunotriquetral joint into flexion. If ligamentous repair between scaphoid and lunate is not possible, drill hole can be made directly through scaphoid and lunate in oblique directions so that hole perforates midportion of their contiguous articular surfaces. Wire loop using 20-gauge wire passed through parallel dorsal palmar holes in scaphoid and lunate provides internal suture that gives measure of security for repairs of this type.