Resection of the Distal Scaphoid for Scaphotrapeziotrapezoid Osteoarthritis

Abstract

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12-61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119 degrees. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.

Excisional Arthroplasty for Scaphotrapeziotrapezoidal Osteoarthritis

“…Splinting, anti-inflammatory drugs, intra-articular corticoid injections, and physiotherapy are often successful in bringing these wrists back to a painless situation. [1][2][3] Surgery is indicated only when conservative treatment fails to relieve the patient's symptoms.…”

Arthroscopic Resection Arthroplasty for Treatment of Combined Carpometacarpal and Scaphotrapeziotrapezoid (Pantrapezial) Arthritis

“…[7][8][9][10][11] Arthroscopy of the STT joint has been described for the purpose of diagnosing, staging and treating STT arthritis. [12][13][14][15][16][17][18][19][20] Arthroscopic debridement of STT arthritis has been reported to have a 90% satisfaction rate at 3-year follow-up. 18 Other authors have reported improvement in pain, mobility, and strength following ARA of the STT joint.…”

“…Patient satisfaction was comparable for both groups; however, STT resection arthroplasty without interposition showed substantially greater range of motion compared to patients with soft tissue interposition. 20 The purpose of the study was to evaluate the early results of ARA of both the CMC and STT joints for patients with pantrapezial arthritis. Although the results of ARA for the CMC and STT independently have been good, results for the combined procedure for pantrapezial arthritis are lacking.…”

Symptomatic Scaphotrapeziotrapezoid Carpal Coalition: The Natural History and a Surgical Option for Treatment

“…These patients had resection of the coalition (all STT), with limited resection of the distal scaphoid. Distal scaphoid resection has been described [30] for the treatment of symptomatic STT arthritis and was thought by the authors to be a sensible way of improving symptoms in these patients, not only helping to preserve range of motion and function but also pain.…”