Resection of the distal pole of the scaphoid for scaphoid nonunion with radioscaphoid and intercarpal arthritis1 ,

Presented in part at the third combined meeting of the Japanese and American Societies for Surgery of the Hand, Maui, HI, March 2000, and at the 7th Congress of the Federation of the European Societies for Surgery of the Hand, Barcelona, Spain, June 2000.
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Abstract

Purpose: The treatment of scaphoid nonunion with degenerative arthritis poses a clinical problem that is particularly challenging in cases of associated dorsal intercalated segmental instability collapse, radiocarpal and intercarpal degenerative changes, and poor scaphoid bone quality. The purpose of this study was to report our clinical experience performing a distal scaphoid resection for symptomatic scaphoid nonunion in patients with either radioscaphoid or intercarpal arthritis who have had multiple surgeries.

Methods: Nine patients with recalcitrant scaphoid nonunion and associated degenerative arthritis treated by resection of the distal scaphoid fragment were evaluated both clinically and radiographically. Eight patients were male and one patient was female; the average follow-up period was 28.6 months (range, 12–52 mo).

Results: Seven patients reported pain with daily use and the remaining 2 patients reported mild pain with light work before surgery, whereas after surgery 4 of the 9 patients had no wrist pain and the remaining 5 patients had only mild pain with strenuous activity. The wrist range of motion improved from 70° (51.4% of the opposite wrist) to 140° (94% of the opposite wrist) and grip strength improved from 18 kg (40% of the opposite wrist) to 30 kg (77% of the opposite wrist). Clinical results were excellent in 6 patients and good in 3 patients based on a modified Mayo wrist-scoring chart. Radiographically neither additional degeneration nor progress of degenerative changes was noted after surgery in 8 patients. Newly developed degenerative arthritis occurred at the proximal scapholunate capitate articulation in the remaining patient who has a type II lunate, which had a facet (medial facet) articulation with the hamate.

Conclusions: The results of this study showed that distal scaphoid resection produces a satisfactory clinical outcome, requires only a short period of immobilization, and should be considered one of the surgical options for long-standing scaphoid nonunion with either radioscaphoid or intercarpal degenerative arthritis. Nevertheless care must be taken in performing this procedure on patients whose preoperative radiograph show a type II lunate.

Section snippets

Patients and methods

Since 1997 our facilities have treated 11 patients with symptomatic scaphoid nonunion associated either radioscaphoid or intercarpal degenerative changes and carpal malalignment with resection of the distal pole of the scaphoid. Of these 11 patients 9 (8 men and 1 woman) who were monitored for more than 1 year were included in the present study. One of the excluded 2 patients was within 1 year from surgery and 1 failed to continue the follow-up evaluation. The average age of our subjects was

Results

The patients’ clinical assessments are summarized in Table 2. Seven patients reported pain with daily use and the remaining 2 patients reported mild pain with light work before surgery whereas after surgery 4 of the 9 patients had no wrist pain and the remaining 5 patients had only mild pain with strenuous activity. All patients returned to their preoperative jobs. The wrist range of motion improved in the flexion-extension arch from 70° ± 32° before surgery to 140° ± 21° after surgery (from

Discussion

Conventional bone grafting such as the Matti-Russe inlay graft technique has been described as the most common treatment of established scaphoid nonunion, with successful healing in 70% to 90% of cases.7, 8, 9 Scaphoid nonunion persisting after a failed previous bone graft or other procedure, however, still is clinically challenging. Several methods have been used to treat recalcitrant nonunions (those that do not improve after an initial surgical procedure), including repeat bone grafting,10

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Supported in part by grants (no. 966007 and 016006) from the Central Research Institute of Fukuoka University, Fukuoka, Japan.

1

No benefits in any form have been received or will be received by a commercial party related directly or indirectly to the subject of this article.

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