Resection of the Distal Pole of the Scaphoid in Symptomatic Scaphotrapeziotrapezoid Osteoarthritis and Symptomatic Scaphoid Nonunion

Abstract

Purpose: Resection of the distal pole of the scaphoid is one of the surgical techniques applied for the treatment of painful scaphotrapeziotrapezoid osteoarthritis (STT-OA) and nonunion of fractures in the distal part of the scaphoid. Very few studies report on the outcome of this technique. The purpose of this study is to evaluate the midterm outcomes in a consecutive series of patients. Methods: This is a retrospective study in which we evaluated 13 patients (15 wrists) with a mean follow-up of 4.1 years. The indication for surgery was in all cases a STT-OA. We evaluated objective functional outcome measures (range of motion and grip strength) and patient-reported outcome measures (visual analogue scale for pain, Michigan Hand Questionnaire [MHQ], and Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]). The degree of dorsal intercalated segmental instability (DISI) and the postoperative complications were also assessed. Results: Extension and flexion averaged 61.6° and 74.3°, while radial and ulnar deviation averaged 16.7° and 27.8°, respectively. Grip strength at position 1 to 5, respectively, averaged 16.0, 23.6, 21.5, 18.3, and 15.6 kg. Reported pain averaged 2.1/10, MHQ 76.4/100, and QuickDASH 25.2/100. A mild postoperative DISI deformity was observed in 13 wrists with an average lunocapitate angle of 22.1° (range, 0°-44°) on radiographic evaluation without a correlation with reported pain scores. None of the opposite wrists, whether with or without STT-OA, displayed DISI deformity. The only observed complication was a complex regional pain syndrome in 1 case. Discussion: The midterm results for distal pole resection of the scaphoid in the treatment of STT-OA and scaphoid nonunion are satisfactory. Almost all patients develop a mild degree of DISI deformity, but this does not affect the outcome. Objective/Hypothesis: Proprioception and sensorimotor modalities have been used in rehabilitation to treat neurological and joint injuries. Following distal radius fractures (DRF), there is a temporary sensorimotor loss that should be addressed during postoperative therapy. We designed an evaluation and treatment protocol aimed at sensorimotor evaluation and treatment and trialed it on a pilot series of patients following surgery for DRF. The purpose of this prospective study was to compare the outcomes of patients following surgery for DRF treated using our specific sensorimotor treatment protocol with patients treated after surgery according to postoperative standard of care. We hypothesized that patients treated using our treatment protocol will have better functional results at 3 months postsurgery. Methods: Because sensorimotor response loops are complex and it is difficult to isolate the effect of the different types of input, both the evaluation and the treatment protocols included a comprehensive sensorimotor panel. The patients were treated once a week in therapy and pursued a home therapy protocol. Thirty-four patients following surgery for DRF were randomized into a focused sensorimotor postope...