Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Nonunion: Systematic Review and Meta-analysis

Mayfield, Cory K.; Gould, Daniel J.; Dusch, Marie N.; Mostofi, Amir

doi:10.1177/1558944718760002

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…Flexionextension arc is not affected by this procedure, unlike other salvage procedures such as 4 corner fusion and PRC. 6,7,13,14 Lunate extension, or DISI deformity, was noted by Garcia-Elias et al 5 for patients undergoing distal scaphoidectomy for STT arthritis, with an average of 12° of lunate extension. This "iatrogenic" DISI deformity did not correlate with adverse midterm functional outcomes.…”

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

“…Clinical studies also demonstrate favorable outcomes for this procedure in long-term follow-up of 15 years, 6 with a recent meta-analysis suggesting that distal scaphoidectomy outperforms PRC and 4CF in all clinical parameters including grip strength, range of motion (ROM), pain, and other functional outcomes scores. 7 The second indication for distal pole scaphoidectomy is STT arthritis. Garcia-Elias et al 5 reported improved pain and function, without impairment in ROM, with patients with isolated STT arthritis treated with this procedure.…”

Section: Introductionmentioning

confidence: 99%

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How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection

Kadar

Grewal

Padmore

et al. 2020

Hand (New York, N,Y.)

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Background: Resection of the distal pole of the scaphoid has been advocated as a simple alternative to other wrist salvage procedures for scaphoid nonunion advanced collapse and scaphotrapezio-trapezoid arthritis. However, the extent of scaphoid that may be resected without adversely affecting carpal kinematics has never been clearly defined. Methods: Seven cadaveric upper extremities were tested in a custom motion wrist simulator. A 3-stage sequential sectioning of the distal scaphoid protocol was performed in 25% increments then cyclic active wrist flexion-extension and dart thrower’s motion trials were recorded. Results: The extent of distal scaphoid resection had no effect on overall wrist range of motion. The lunate assumed a more extended position following resection of the distal scaphoid compared to intact. At 25%, 50%, and 75% of distal scaphoid resection, the lunate extended to 13.32° ± 9.4°, 23.43° ± 7.5°, and 15.81° ± 16.9°, respectively. The capitate migrated proximally with 25% and 50% distal scaphoidectomy, and proximally and radially with 75% of the scaphoid resected. Resection of 75% of the scaphoid resulted in unstable wrist kinematics. Conclusions: Resection of up to 25% of the distal scaphoid did not significantly influence carpal kinematics and induced mild lunate extension deformity. Resection of 50% of the scaphoid induced further and potentially clinically significant lunate extension and dorsal intercalated segment instability. Further removal of 75% of the distal scaphoid induced capitate migration radially and unpredictable wrist kinematics. Consequently, removal of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection

Kadar

Grewal

Padmore

et al. 2020

Hand (New York, N,Y.)

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“…59 Distal scaphoid resection is another option: 19 patients treated with this option exhibited a mean visual analog scale (VAS) score for pain of 0.9, grip strength of 83% of the contralateral wrist, wrist ROM of 79% of the contralateral wrist, and no development of radiolunate arthritis, 60 with a meta-analysis demonstrating 93% of patients returning to work in a mean time of 6.9 weeks. 61 Once SNAC progresses beyond the radioscaphoid joint, other treatment options, such as proximal row carpectomy (PRC) and four-corner arthrodesis (4CF), should be considered. Mulford et al reviewed 52 articles, finding that both PRC and 4CF improve pain.…”

Section: Salvage Optionsmentioning

confidence: 99%

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Samade,

Awan

2024

J Wrist Surg

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Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV

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“…When degenerative changes start, pain is caused by wear of articular cartilage rather than nonunion, so it is standard to perform salvage or arthroplasty surgery instead of an osteosynthesis procedure. Although for the first stage pain can be improved by resection of the radial styloid process and osteosynthesis of the scaphoid (Mayfield et al., 2019), in the second and third stages there are degenerative changes in the mid-carpal joint, so even if the osteosynthesis is successful, the pain may remain (Luchetti, 2018; Vutescu et al., 2018). Therefore, it is important to determine whether the arthritis has progressed to Stage 2 or not.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging analysis of the distribution of cartilage damage in scaphoid nonunion

Jung,

Kim,

Chung

et al. 2023

J Hand Surg Eur Vol

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This study aimed to evaluate the distribution and severity of cartilage damage using magnetic resonance imaging in patients with scaphoid nonunion without advanced wrist arthritis. We retrospectively analysed MRI of patients who underwent osteosynthesis for scaphoid nonunion. Cartilage damage was assessed in eight wrist regions using a modified Whole-Organ Magnetic Resonance Imaging Score. The frequencies of regions affected by any cartilage damage (Score ≥2.5) depicted on MRI were analysed. The study included 32 patients (31 men and one woman), with a mean age of 32 years (SD 11). The distal radioscaphoid (29/32), scaphotrapeziotrapezoid (STT) (22/32), proximal radioscaphoid (14/32) and scaphocapitate (11/32) joints were most commonly affected by degenerative cartilage damage. The STT and proximal radioscaphoid joint were especially likely to be involved in early-stage scaphoid nonunion advanced collapse. We recommend that surgeons should investigate the cartilage status of these joints during decision-making for scaphoid nonunion surgery. Level of evidence: III

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Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Nonunion: Systematic Review and Meta-analysis

Abstract: Given favorable outcomes, our analysis suggests that distal scaphoid excision may be a favorable, low-risk treatment for scaphoid nonunion without eliminating more extensive options such as 4CF and wrist arthrodesis.

Cited by 4 publications

References 28 publications

How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection

How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Magnetic resonance imaging analysis of the distribution of cartilage damage in scaphoid nonunion

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