David S Ruch1, Anastasios Papadonikolakis. 1. Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
Abstract
PURPOSE: To evaluate the results of resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed prior surgical treatment. METHODS: Thirteen patients who were treated with resection of the scaphoid distal pole for persistent nonunion after previous surgical treatment were included in this study. The mean follow-up period was 5 years. Evaluation included measurement of wrist range of motion, assessment of pain, and evaluation of radiographic parameters. The Disabilities of the Arm, Shoulder, and Hand score was used to determine the functional outcome after the excision. RESULTS: Before surgery all but 1 patient reported pain. After surgery 2 patients presented with mild pain during strenuous activity. Mean wrist flexion and extension increased significantly, by 23 degrees and 29 degrees, respectively. The postoperative Disabilities of the Arm, Shoulder, and Hand score was 25 +/- 19 points. There was a significant increase in the radiolunate angle, indicating dorsal intercalated segment instability deformity in 6 patients. CONCLUSIONS: Scaphoid distal pole excision remains a valuable treatment option for patients for whom multiple attempts at union have failed previously and who have no associated complete scapholunate ligament tears. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
PURPOSE: To evaluate the results of resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed prior surgical treatment. METHODS: Thirteen patients who were treated with resection of the scaphoid distal pole for persistent nonunion after previous surgical treatment were included in this study. The mean follow-up period was 5 years. Evaluation included measurement of wrist range of motion, assessment of pain, and evaluation of radiographic parameters. The Disabilities of the Arm, Shoulder, and Hand score was used to determine the functional outcome after the excision. RESULTS: Before surgery all but 1 patient reported pain. After surgery 2 patients presented with mild pain during strenuous activity. Mean wrist flexion and extension increased significantly, by 23 degrees and 29 degrees, respectively. The postoperative Disabilities of the Arm, Shoulder, and Hand score was 25 +/- 19 points. There was a significant increase in the radiolunate angle, indicating dorsal intercalated segment instability deformity in 6 patients. CONCLUSIONS: Scaphoid distal pole excision remains a valuable treatment option for patients for whom multiple attempts at union have failed previously and who have no associated complete scapholunate ligament tears. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.