Results After Radioscapholunate Arthrodesis With or Without Resection of the Distal Scaphoid Pole

Mühldorfer-Fodor, Marion; Ha, Hue Phan; Hohendorff, B.; Löw, Steffen; Prommersberger, K.-J.; Schoonhoven, Jörg van

doi:10.1016/j.jhsa.2012.08.009

Cited by 41 publications

(31 citation statements)

References 16 publications

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“…Several authors reported this finding but not always provided the results on pain or strength. 10,14,15 The global OA rate after RSL fusion ranges from 0 to 100% in the literature, [8][9][10][11][12] but several series did not distinguish the involved joint: STT or midcarpal (e.g., scaphocapitate, lunocapitate, or triquetrohamate). Although the STT joint anatomically belongs to the midcarpal joint, we separated the two localizations of OA because their origins are different.…”

Section: Discussionmentioning

confidence: 99%

“…6,14,25 In agreement with the literature, our results showed that DSE significantly reduced STT OA. 8,10,[13][14][15]26 We described three cases of STT OA despite DSE and suspected that the procedure was secondary to an incomplete excision.…”

Section: Discussionmentioning

confidence: 99%

“…The nonunion rate after RSL fusion has ranged from 0 to 29%, depending on the series. [8][9][10]13,15,26 This worrisome rate may have several explanations. First, technical errors could have resulted in a lack of bone fixation, especially K-wire, in most of the older series.…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of the literature revealed only 4 (4%) cases of nonunion from among 103 patients (►Table 6). 8,10,[13][14][15]26 Garcia-Elias et al reported that the lengthening of the lever arm due to fusion increased the stresses transmitted from the distal radius to the scaphoid and, thus, could promote nonunion. 14 We note several limitations of this series.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] Given those complications and the restricted motion after RSL fusion, many authors have modified the procedure by adding distal scaphoid excision (DSE, i.e., excision of the distal pole of the scaphoid) to improve motion in flexion and radial deviation while decreasing scaphotrapeziotrapezoidal (STT) OA. 8,10,[13][14][15] Likewise, excision of the triquetrum (ET) has been proposed to improve motion in extension and ulnar deviation while removing the ulnocarpal impaction. 10,13 To date, no study has investigated the prognostic factors for achieving good clinical or radiographic outcomes after RSL fusion.…”

mentioning

confidence: 99%

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Radioscapholunate Fusion for Radiocarpal Osteoarthritis: Prognostic Factors of Clinical and Radiographic Outcomes

Degeorge

Montoya-Faivre²,

Dap³

et al. 2019

Jnl Wrist Surg

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Background Radioscapholunate (RSL) fusion is a surgical option to manage radiocarpal osteoarthritis. Many authors upgrade the procedure by adding distal scaphoid excision with or without excision of the triquetrum. Our objective was to identify the prognostic factors for good clinical and radiographic outcomes of RSL arthrodesis. Purpose Distal scaphoid excision improves both scaphotrapeziotrapezoidal osteoarthritis and radiocarpal fusion, and excision of the triquetrum is not critical to achieving satisfactory outcomes. Methods In this retrospective and bicentric investigation, all wrists were managed with RSL fusion for posttraumatic radiocarpal osteoarthritis. A total of 85 patients were included and evaluated at the revision by clinical (pain, wrist motion, and strength), functional (Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Related Wrist Evaluation score, and Modified Mayo Wrist Score), and radiological (scaphotrapeziotrapezoidal, midcarpal osteoarthritis, and radiocarpal nonunion) examinations. We assessed prognostic factors for clinical and radiographic (osteoarthritis and nonunions) outcomes. Results The average follow-up was 9.1 years (1–21.4). Work-related accidents adversely impacted the clinical outcomes, and distal scaphoid excision significantly improved them and decreased scaphotrapeziotrapezoidal osteoarthritis and nonunion. Neither distal scaphoid excision nor excision of the triquetrum influenced midcarpal osteoarthritis. Radiocarpal fusion was significantly promoted by memory staples and bone grafting. Discussion Distal scaphoid excision should be preferred to improve the functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. Excision of the triquetrum appears to be an alternative to radioulnar resection–arthroplasty to solve ulnocarpal impaction syndrome. Strict surgical procedure must be observed to promote RSL fusion combining solid bone fixation and the use of bone graft. Level of evidence This is a level IV, case series, retrospective series.

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