Timothy B Larson1, Peter J Stern2. 1. Department of Orthopaedics, University of Cincinnati College of Medicine, Cincinnati, OH. Electronic address: TimothyLarson@texashealth.org. 2. Department of Orthopaedics, University of Cincinnati College of Medicine, Cincinnati, OH.
Abstract
PURPOSE: To evaluate the success of reduction and association of the scaphoid and lunate with a fibrous union in an effort to evaluate the technique's validity and reproducibility. METHODS: A retrospective review was performed on 7 patients (8 wrists) with an average follow-up of 38 months. Static and grip radiographs were examined in the preoperative, immediate postoperative, and final follow-up settings to evaluate scapholunate (SL) diastasis, SL angle, hardware position, and complications. At final follow-up, grip strength and wrist range of motion were recorded, and patients completed the Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation outcome questionnaires. RESULTS: Radiographic success, defined by maintenance of corrected SL diastasis, absence of dorsal intercalated segmental instability, and no progression of SL advanced collapse was achieved in 3 of the 8 wrists. One wrist developed radioscaphoid arthritis. No patients required a salvage procedure. Despite the loss of reduction that occurred in all patients, the patients' disability remained minimal as detected by the scores on the outcome measures. CONCLUSIONS: The procedure was ineffective in providing stability about the SL interval. With a majority of patients experiencing early radiographic failure of the procedure in the short term, our experience suggests that the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores, which may be reflective of the short follow-up duration for this series. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: To evaluate the success of reduction and association of the scaphoid and lunate with a fibrous union in an effort to evaluate the technique's validity and reproducibility. METHODS: A retrospective review was performed on 7 patients (8 wrists) with an average follow-up of 38 months. Static and grip radiographs were examined in the preoperative, immediate postoperative, and final follow-up settings to evaluate scapholunate (SL) diastasis, SL angle, hardware position, and complications. At final follow-up, grip strength and wrist range of motion were recorded, and patients completed the Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation outcome questionnaires. RESULTS: Radiographic success, defined by maintenance of corrected SL diastasis, absence of dorsal intercalated segmental instability, and no progression of SL advanced collapse was achieved in 3 of the 8 wrists. One wrist developed radioscaphoid arthritis. No patients required a salvage procedure. Despite the loss of reduction that occurred in all patients, the patients' disability remained minimal as detected by the scores on the outcome measures. CONCLUSIONS: The procedure was ineffective in providing stability about the SL interval. With a majority of patients experiencing early radiographic failure of the procedure in the short term, our experience suggests that the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores, which may be reflective of the short follow-up duration for this series. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Authors: Alexander Kaltenborn; Sebastian Hoffmann; Andreas Settje; Peter M Vogt; André Gutcke; Mike Rüttermann Journal: BMC Musculoskelet Disord Date: 2017-01-31 Impact factor: 2.362