Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy

García-Elias, Marc; Lluch, Alberto; Ferreres, Àngel; Zorli, I. Papini; Rahimtoola, Zulfi

doi:10.1016/j.jhsa.2004.09.001

Cited by 132 publications

(105 citation statements)

References 26 publications

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“…5,6,7,20,22 As all previous outcomes studies after RSL fusions have only reported postoperative motion measured in the traditional orthogonal planes, it is possible that these measurements underestimate the remaining functional capacity of these wrists. 1,3,4,8,23 We were not able to detect a change in the orientation and location of the HAM axes of the capitate for flexion/extension after pinning. However, due to the high degree of variability within the individual HAM axes associated with each position, it is premature to say that direction of motion is not altered during RSL fusion.…”

Section: Discussioncontrasting

confidence: 56%

“…A recent series by Garcia-Elias et al has supported distal scaphoid excision, and Hastings has reported excising the triquetrum during RSL fusion. 23,24 Excision of the distal pole of the scaphoid would have likely led to a greater arc of wrist motion; however, the distal scaphoid was not excised in this experiment for 2 reasons. First, we aimed to evaluate the kinematic effects of this fusion without violating the wrist capsule and without surgically disrupting the wrist ligaments in an effort to minimize the chance of producing kinematic alterations during fixation.…”

Section: Discussionmentioning

confidence: 99%

“…In view of a lack of completely stable scaphoid and lunate fixation, our results likely overestimate total wrist motion slightly, especially in the anti-dart-thrower's path, while underestimating the kinematic alterations at the individual remaining carpal articulations. Additionally, the changes in 23,24 Excision of the distal pole of the scaphoid would have likely led to a greater arc of wrist motion; however, the distal scaphoid was not excised in this experiment for 2 reasons. First, we aimed to evaluate the kinematic effects of this fusion without violating the wrist capsule and without surgically disrupting the wrist ligaments in an effort to minimize the chance of producing kinematic alterations during fixation.…”

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confidence: 99%

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Simulated Radioscapholunate Fusion Alters Carpal Kinematics While Preserving Dart-Thrower's Motion

Calfee

Leventhal

Wilkerson

et al. 2008

The Journal of Hand Surgery

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Purpose-Midcarpal degeneration is well documented after radioscapholunate fusion. This study tested the hypothesis that radioscapholunate fusion alters the kinematic behavior of the remaining lunotriquetral and midcarpal joints, with specific focus on the dart-thrower's motion.Methods-Simulated radioscapholunate fusions were performed on 6 cadaveric wrists in an anatomically neutral posture. Two 0.060-in. carbon fiber pins were placed from proximal to distal across the radiolunate and radioscaphoid joints, respectively. The wrists were passively positioned in a custom jig toward a full range of motion along the orthogonal axes as well as oblique motions, with additional intermediate positions along the dart-thrower's path. Using a computed tomography-based markerless bone registration technique, each carpal bone's three-dimensional rotation was defined as a function of wrist flexion/extension from the pinned neutral position. Kinematic data was analyzed against data collected on the same wrist prior to fixation using hierarchical linear regression analysis and paired Student's t-tests.Results-After simulated fusion, wrist motion was restricted to an average flexion-extension arc of 48°, reduced from 77°, and radial-ulnar deviation arc of 19°, reduced from 33°. The remaining motion was maximally preserved along the dart-thrower's path from radial-extension toward ulnarflexion. The simulated fusion significantly increased rotation through the scaphotrapezial joint, scaphocapitate joint, triquetrohamate joint, and lunotriquetral joint. For example, in the pinned wrist, the rotation of the hamate relative to the triquetrum increased 85%. Therefore, during every 10° of total wrist motion, the hamate rotated an average of nearly 8° relative to the triquetrum after pinning versus 4° in the normal state.Conclusions-Simulated radioscapholunate fusion altered midcarpal and lunotriquetral kinematics. The increased rotations across these remaining joints provide one potential explanation for midcarpal degeneration after radioscapholunate fusion. Additionally, this fusion model confirms the dart-thrower's hypothesis, as wrist motion after simulated radioscapholunate fusion was primarily preserved from radial-extension toward ulnar-flexion. KeywordsCadaver; fusion; lunate; radius; scaphoid Degeneration of the radiocarpal joints is the end result of interrelated traumatic, inflammatory, and metabolic processes. Intra-articular distal radius fractures, perilunate Copyright © 2008 Nevertheless, RSL fusion is not without complication. Notably, published clinical outcomes after RSL fusion report midcarpal arthritis in up to 50% of these patients. [1][2][3][4] This will become symptomatic in some patients and may even require conversion to a total wrist arthrodesis. Likely multifactorial in nature, the etiology of this midcarpal degeneration has not been established. Proposed theories explain the degeneration as a delayed effect of the initial insult or as an effect of altered joint environments resulting from the fusion....

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Simulated Radioscapholunate Fusion Alters Carpal Kinematics While Preserving Dart-Thrower's Motion

Calfee

Leventhal

Wilkerson

et al. 2008

The Journal of Hand Surgery

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“…10.4 ). Based on this, if a painful SLD is not reducible and needs to be stabilized by an arthrodesis, fusing the radioscapholunate joint rather than the midcarpal joint may be a reasonable choice [ 34 ]. That option would be particularly indicated if, aside from the SLD, there are abnormalities in the radiocarpal joint.…”

Section: Radio-scapho-lunate Fusion Plus Distal Scaphoidectomymentioning

confidence: 99%

“…Fusing the radiocarpal joint eliminates pain induced by local synovitis, while stabilizing the proximal component of the midcarpal joint. In order to avoid the STT joint becoming symptomatic, as the consequence of localized radioscaphoid impingement, routine excision of the distal third of the scaphoid has been suggested [ 34 ]. With this technique, the midcarpal "ball-and-socket" articulation is liberated from its lateral constraint and allows more than 50 % of the overall wrist motion.…”

Section: Radio-scapho-lunate Fusion Plus Distal Scaphoidectomymentioning

confidence: 99%