- Email: [email protected]
Session 13: Forearm and wrist 4
5.5
SESSION 13: FOREARM AND WRIST 4 TH-13-106
TH-13-107
TH-13-108
TH-13-109
TH-13-110
TH-13-111
TH-13-112
RESULTS AFTER RECONSTRUCTION OF SCAPHOID NON-UNION D. HERREN, S. WOHLGEMUTH, B.R. SIMMEN ZURICH, SWITSERLAND . . . . . . . . . . . . . . . . . . . . . . . ... .. . . .
. . .. . .. .
..
.. . .
56
..
56
ALTERNATIVE VASCULARIZED GRAFTS FOR LONGSTANDING SCAPHOID NONUNIONS WITH BONE LOSS Z. DAILIANA, V. ZACHOS, A. KARANTANAS, S. VARITIMIDIS, K.N. MALIZOS LARISSA, GREECE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
PALMAR VASCULARIZED BONE GRAFTS FOR SCAPHOID NONUNION M. HAERLE, G. VANDEPUTTE, CH. MATHOULIN TUBINGEN, GERMANE PARIS,FRANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
PROXIMAL ROW CARPECTOMY THROUGH VOLAR APPROACH G. PILATO, A. BINI, F. BALDO, L. MURENA VARESE,ITALY . . . . . . . . . . . . . . . . . . . . . . . . . . . ~. . . . . . , . . . . .
. ... . .. ... .. .. .. . .. . . . .
57
TEN YEARS OF PROXIMAL ROW CARPECTOMY THROUGH A PALMAR APPROACH RICCARDO LUCHETTI DEPARTMENT OF SURGERY FOR THE HAND, STATE HOSPITAL OF SAN MARINO, VIA PIETRO DA RIMINI 4,479OO RIMINI, 4790 RIMINI, ITALY A. ATZEI VERONA,ITALY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .,
57
RADIOSCAPHOLUNATE FUSION + DISTAL SCAPHOIDECTOMY FOR THE TREATMENT OF RADIOCARPAL ARTHROSIS M. GARCIA-ELIAS, A.L. LLUCH BARCELONA,SPAIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
FURTHER EXPERIENCE WITH THE LIMITED COMBINED APPROACH FOR SCAPHOID NONUNION F. DEL PfiAL, F. HERRERO, F.J. GARCiA-BERNAL, G. PIDEMUNT, L. CEREZAL SAMANDER, SPAIN . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. . . .. .. .. .. .. .. .. . . ..
THE JOURNAL
OF HAND
SURGERY
VOL. 288 SUPPLEMENT
I
SESSION 13: FOREARM AND WRIST 4 106. RESULTS NON-UNION
AFTER
RECONSTRUCTION
OF SCAPHOID
Daniel Herren, S. Wohlgemuth, B.R. Simmen. Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switserland Introduction: Scaphoid non-union occurs in the mainly young active group of patients. It is therefore important to analyze the results of a reconstruction not only with clinical and radiological parameters but also in the light of the impact in the activities of daily living and the ability to work. Material and methods: Thirty-one patients with a scaphoid nonunion underwent a reconstruction of the scaphoid with nonvacularized iliac bone graft and Herbert screw fixation. After an average follow-up of 79 months the clinical and radiological exam was evaluated together with the DASH questionnaire. Results: Thirty of the thirty-one reconstructions healed. One nonunion showed no signs of screw loosening. The DASH score showed a good outcome with an average of 9 points when 0 means no disability and 100 points a maximum of disability. Six patients had to change their job, 30/31 are fully employed. All but one patient were satisfied with the result. Discussion: The analyzed DASH score showed a good correlation between objective and subjective results. In the light of this evaluation and with the knowledge of the unfavorable natural course of scaphoid non-union a generous indication for reconstruction in young active patients should be considered.
107. FURTHER COMBINED
EXPERIENCE APPROACH FOR
WITH THE LIMITED SCAPHOID NONUNION
Francisco de1 Pihal, F. Herrero, F.J. Garcia-Bemal, G. Pidemunt, L. Cerezal. Hospital Mutua MontaAesa/Private Practice. Calderdn de la Barca 16, E-39002 Santandel; Spain Introduction: We identified a subgroup of patients with scaphoid non-union for whom standard methods of treatment are inappropriate. They all showed a flexed scaphoid required a palmar wedge to avoid a malunion and a too small proximal pole to assure a rigid tixation by a palmarly inserted screw. For those cases we propose the limited combined approach: by a limited palmar approach (preserving most of the RSC ligament intact) a wedge is inserted, then by a minimal dorsal route the scaphoid is stabilized by a retrograde Herbert screw. Materials and methods: From July 1996 to January 2002 we have operated on 18 patients with this technique: 14 had a scooped out scaphoid (hollowed out scaphoid) or a junctional nonunion (middle-proximal pole junction), 2 were referred for postfixation failure, and 2 have had a trans-scapho-perilunate dislocation. Results: Union was achieved in 17/18 with a generalized improvement in scaphoid shape and carpal angles. One patient had persistent pain in spite of union. Conclusions. This technique should be considered for scaphoid nonunion that require a palmar wedge and at the same time the proximal pole is too small for assure a rigid fixation by a palmarly inserted screw.
108. ALTERNATIVE LONGSTANDING
VASCULARIZED GRAFTS FOR SCAPHOID NONUNIONS WITH BONE
LOSS
Z. Dailiana, V. Zachos, A. Karantanas, S. Varitimidis, K.N. Malizos. Orthopaedic Surgery Department, University Thessaly, L.urissa, Greece
of
Introduction-Aim: Longstanding scaphoid nonunions (SN) cause secondary changes limiting joint function and impose difficulties in establishing union. Distal radius vascularized bone grafts (VBG) have been prospectively used for the treatment of longstanding SN with bone loss. Methods: Forty-three patients were treated with VBG: 41 with 3.9 years old SN and 2 with enchondromas. Six patients had unsuccessful previous surgical procedures and 11 had scapho-styloid arthritis (SSA). A dorsal VBG was used in 37 patients (proximal pole nonunions) and a palmar VBG in 5 (waist nonunions). A distal radius closed wedge osteotomy was also performed in 7 patients with SSA. Results: Follow-up ranged from 11 to 96 months. Union was assessed on X-rays and graft viability in MRI scans. Union was accomplished within 7- 1 I weeks. Scaphoid length was reconstructed in 88% of contralateral site and ROM and grip strength improved significantly. Pain was eliminated in 34 patients but was present in strenuous activities in cases of SSA. All patients returned to their previous occupation within 4-6 months. Discussion and Conclusions: VBG lead to rapid and successful healing with reconstruction of length and angulation. The choice of the most suitable VBG depends on the location of the nonunion. An additional procedure is necessary for cases with established SSA.
109. PALMAR SCAPHOID
VASCULARIZED NONUNION
BONE
GRAFTS
FOR
Max Haerle I, G. Vandeputte’, Ch. Mathoulin*. ‘Hand & Plastic Surgery, Bg Clinic, University of Tiibingen, Tiibingen, Germany: ‘Institut de la Main, Paris, France Introduction: We analyzed the results of 94 scaphoid non-unions treated with a vascularized bone graft from the distal palmar radius. The grafts are vascularized by the palmar carpal artery. Material: There were 15 female and 79 male patients, 41 left and 53 right wrists. The mean age at surgery was 30.6 years (range 15-61). Results: Median radiographic evidence of union was achieved after 8.0 weeks (range 5-24~) in 84 patients (89%). Overall there was a slight increase in range of motion postoperatively. Patients noted a significant decrease in pain postoperatively (p < 0.0017). The functional result was graded as excellent in 54 cases, good in 20 cases, fair in 13 cases and poor in 5 cases. Statistical analysis as bivariate and multivariate correlations were calculated and will be discussed. Discussion. There was a clear correlation between the stage of pseudarthrosis and the final outcome of surgery, best results were
THE JOURNAL
OF HAND
SURGERY
VOL. 28B SUPPLEMENT
obtained in patients with stage 2A in Alnot’s classification. The use of a vascularized bone graft harvested from the palmar aspect of the radius often results in union of scaphoid nonunion.
110. PROXIMAL APPROACH
ROW
CARPECTOMY
THROUGH
57
I
VOLAR
Giorgio Pilato, A. Bini, F. Baldo, L. Murena. Institute qf Orthopaedics and Trauma “M. Boni”, Viale Borri 57, 2110: Varese, Ital) Proximal Row Carpectomy (PRC) has been utilized mainly in post-traumatic wrist conditions to relieve pain and restore stability while preserving motion. The use of volar approach to perform PRC has been reported to markedly improve functional and to wrist motion compared with the results of dorsal approach. We have performed PRC through a volar approach in eight patients with diagnosis of Kienbiick’s disease (Lichtman BIB) in one case, and radio-scaphoid degenerative arthritis in seven cases. Results at an average follow-up of 20 months (12-42) show relief of pain in six cases with one patient reporting mild pain after wrist exertion and one complaining of moderate pain in daily activities. Average range of motion was 57” flexion, 43” extension, 3 1’ ulnar deviation and 7” radial deviation, with total flexion-extension arc attaining 76% of opposite wrist. Grip strength was 78% of contralateral wrist. X-rays did not’t show any degenerative changes of the new radio-capitate joint. We conclude that PRC through volar approach allows better functional results than dorsal approach on comparison of improvement of range of motion; compliance of the patient to the rehabilitation programme is mandatory to improve results; longer follow-up is needed to evaluate the ultimate outcome of the new radio-capitate joint.
111. TEN YEARS OF PROXIMAL ROW CARPECTOMY THROUGH A PALMAR APPROACH RICCARDO LUCHETTI DEPARTMENT OF SURGERY FOR THE HAND, STATE HOSPITAL OF SAN MARINO, VIA PIETRO DA RIMINI 4,479OO RIMINI, 4790 RIMINI, ITALY
Andrea Atzei. Department of Surgery for the Hand, Policlinico Borgo Roma. Verow Italy Introduction: From 1990 to 2000, 30 proximal row carpectomies on 29 patients were done through a palmar approach. METHODS All the patients were evaluated preop and postop according to clinical and radiological parameters. Mayo Wrist Score and DASH Questionnaire were also included. Results: With an average follow-up of 58 months, 26 cases (23 males and 3 females with an average age of 35 years) were evaluated. Preop-postop data were: Pain from 8 to 1; Flex/Ext from 85 to 94; Radial/Ulnar Dev from 39 to 46; Grip Strength (kg) from 22 to 33. The X-ray findings (reduction in articular space and subchondral sclerosis in radiocapitate articulation) were: 5 normal, 5 mild, 9 moderate, 6 fair. No statistical significant correlation was find with clinical outcome. Cineradiography confirmed complete stability of the new articulation during movements of AP and PA stressing, flexionlextension and radial/ulnar wrist deviation.
Nineteen per cent of the patients returned to the previous work within 2 months on average. Discussion and conclusion: We consider that the results following PRC through a palmar approach are satisfactory in terms of rendering the wrist painless, maintaining functional wrist mobility, improving grip strength and allowing return to work.
112. RADIOSCAPHOLUNATE FUSION + DISTAL SCAPHOIDECTOMY FOR THE TREATMENT OF RADIOCARPAL ARTHROSIS Marc Garcia-Elias ‘, Albert0 L. Lluch2. ‘Passe& de la Bonanova, 9, 2” 2’, 08022 Barcelona, Spain; ‘Institut Kaplan, Barcelona, Spain Purpose of the study: Cornminuted articular fractures of the distal radius leaving permanent damage to the radiocarpal cartilage is a condition often treated by a radioscapholunate (RSL) arthrodesis. Once fused to the radius, however, the scaphoid becomes a fixed static constant to the distal row, preventing this to full flexion and/or radial deviation. Any attempt of the distal row to move towards the radial side is likely to increase the stress within the STT joint, making for the development of secondary degeneration at this level. We hypothesized that by adding a distal scaphoidectomy to RSL fusions, the long term results would improve as a consequence of the “ball-and-socket” central component of the midcarpal joint being freed from lateral constrains. Patients and methods: A prospective study of 13 patients (10 male, 3 female; avg: 46 years old, from 22 to 65 years) with post-traumatic degeneration of the radiocarpal joint, were treated by associating a distal scaphoid resection to a regular RSL fusion. The patients have been followed up at an average of 23 months (12-70 months) post surgery. Results: All patients are very satisfied (average: 9.3 in a scale of visual analog scale from 0 tolO), with only some discomfort at the extremes of the retained motion in 5. All, except one who retired, went back to their usual activities. As the radiocarpal joint is fixed and the only motion occurs at the midcarpal level, the overall plane of flexion-extension appears somewhat tilted towards the so-called “dart-throwing” plane of rotation. Wrist flexion-ulnar deviation: 37 f 13” and wrist extension-radial deviation:34 It 22”. Such an oblique plane of motion, however, was not regarded as a problem by the patients, as they considered this quite useful in activities of daily living. Average grip strength: 86% of the contralateral, unaffected side. Conclusion: By adding a distal scaphoidectomy, the average range of rotation obtained in this series (7 1 degrees) appears substantially larger than the 47” reported by Sturzenegger and Biichler ]I] with only a RSL fusion, without the negative consequence of developing an STT arthritis. Therefore, distal scaphoidectomy is recommended in all cases where a badly damaged radiocarpal joint needs to be fused. Reference: [l] Sturzenegger M, Btichler U. Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius. Ann Chir Main Memb Sup 10:207-216. 1991.
SESSION 13: FOREARM AND WRIST 4 TH-13-106
TH-13-107
TH-13-108
TH-13-109
TH-13-110
TH-13-111
TH-13-112
RESULTS AFTER RECONSTRUCTION OF SCAPHOID NON-UNION D. HERREN, S. WOHLGEMUTH, B.R. SIMMEN ZURICH, SWITSERLAND . . . . . . . . . . . . . . . . . . . . . . . ... .. . . .
. . .. . .. .
..
.. . .
56
..
56
ALTERNATIVE VASCULARIZED GRAFTS FOR LONGSTANDING SCAPHOID NONUNIONS WITH BONE LOSS Z. DAILIANA, V. ZACHOS, A. KARANTANAS, S. VARITIMIDIS, K.N. MALIZOS LARISSA, GREECE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
PALMAR VASCULARIZED BONE GRAFTS FOR SCAPHOID NONUNION M. HAERLE, G. VANDEPUTTE, CH. MATHOULIN TUBINGEN, GERMANE PARIS,FRANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
PROXIMAL ROW CARPECTOMY THROUGH VOLAR APPROACH G. PILATO, A. BINI, F. BALDO, L. MURENA VARESE,ITALY . . . . . . . . . . . . . . . . . . . . . . . . . . . ~. . . . . . , . . . . .
. ... . .. ... .. .. .. . .. . . . .
57
TEN YEARS OF PROXIMAL ROW CARPECTOMY THROUGH A PALMAR APPROACH RICCARDO LUCHETTI DEPARTMENT OF SURGERY FOR THE HAND, STATE HOSPITAL OF SAN MARINO, VIA PIETRO DA RIMINI 4,479OO RIMINI, 4790 RIMINI, ITALY A. ATZEI VERONA,ITALY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .,
57
RADIOSCAPHOLUNATE FUSION + DISTAL SCAPHOIDECTOMY FOR THE TREATMENT OF RADIOCARPAL ARTHROSIS M. GARCIA-ELIAS, A.L. LLUCH BARCELONA,SPAIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
FURTHER EXPERIENCE WITH THE LIMITED COMBINED APPROACH FOR SCAPHOID NONUNION F. DEL PfiAL, F. HERRERO, F.J. GARCiA-BERNAL, G. PIDEMUNT, L. CEREZAL SAMANDER, SPAIN . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. . . .. .. .. .. .. .. .. . . ..
THE JOURNAL
OF HAND
SURGERY
VOL. 288 SUPPLEMENT
I
SESSION 13: FOREARM AND WRIST 4 106. RESULTS NON-UNION
AFTER
RECONSTRUCTION
OF SCAPHOID
Daniel Herren, S. Wohlgemuth, B.R. Simmen. Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switserland Introduction: Scaphoid non-union occurs in the mainly young active group of patients. It is therefore important to analyze the results of a reconstruction not only with clinical and radiological parameters but also in the light of the impact in the activities of daily living and the ability to work. Material and methods: Thirty-one patients with a scaphoid nonunion underwent a reconstruction of the scaphoid with nonvacularized iliac bone graft and Herbert screw fixation. After an average follow-up of 79 months the clinical and radiological exam was evaluated together with the DASH questionnaire. Results: Thirty of the thirty-one reconstructions healed. One nonunion showed no signs of screw loosening. The DASH score showed a good outcome with an average of 9 points when 0 means no disability and 100 points a maximum of disability. Six patients had to change their job, 30/31 are fully employed. All but one patient were satisfied with the result. Discussion: The analyzed DASH score showed a good correlation between objective and subjective results. In the light of this evaluation and with the knowledge of the unfavorable natural course of scaphoid non-union a generous indication for reconstruction in young active patients should be considered.
107. FURTHER COMBINED
EXPERIENCE APPROACH FOR
WITH THE LIMITED SCAPHOID NONUNION
Francisco de1 Pihal, F. Herrero, F.J. Garcia-Bemal, G. Pidemunt, L. Cerezal. Hospital Mutua MontaAesa/Private Practice. Calderdn de la Barca 16, E-39002 Santandel; Spain Introduction: We identified a subgroup of patients with scaphoid non-union for whom standard methods of treatment are inappropriate. They all showed a flexed scaphoid required a palmar wedge to avoid a malunion and a too small proximal pole to assure a rigid tixation by a palmarly inserted screw. For those cases we propose the limited combined approach: by a limited palmar approach (preserving most of the RSC ligament intact) a wedge is inserted, then by a minimal dorsal route the scaphoid is stabilized by a retrograde Herbert screw. Materials and methods: From July 1996 to January 2002 we have operated on 18 patients with this technique: 14 had a scooped out scaphoid (hollowed out scaphoid) or a junctional nonunion (middle-proximal pole junction), 2 were referred for postfixation failure, and 2 have had a trans-scapho-perilunate dislocation. Results: Union was achieved in 17/18 with a generalized improvement in scaphoid shape and carpal angles. One patient had persistent pain in spite of union. Conclusions. This technique should be considered for scaphoid nonunion that require a palmar wedge and at the same time the proximal pole is too small for assure a rigid fixation by a palmarly inserted screw.
108. ALTERNATIVE LONGSTANDING
VASCULARIZED GRAFTS FOR SCAPHOID NONUNIONS WITH BONE
LOSS
Z. Dailiana, V. Zachos, A. Karantanas, S. Varitimidis, K.N. Malizos. Orthopaedic Surgery Department, University Thessaly, L.urissa, Greece
of
Introduction-Aim: Longstanding scaphoid nonunions (SN) cause secondary changes limiting joint function and impose difficulties in establishing union. Distal radius vascularized bone grafts (VBG) have been prospectively used for the treatment of longstanding SN with bone loss. Methods: Forty-three patients were treated with VBG: 41 with 3.9 years old SN and 2 with enchondromas. Six patients had unsuccessful previous surgical procedures and 11 had scapho-styloid arthritis (SSA). A dorsal VBG was used in 37 patients (proximal pole nonunions) and a palmar VBG in 5 (waist nonunions). A distal radius closed wedge osteotomy was also performed in 7 patients with SSA. Results: Follow-up ranged from 11 to 96 months. Union was assessed on X-rays and graft viability in MRI scans. Union was accomplished within 7- 1 I weeks. Scaphoid length was reconstructed in 88% of contralateral site and ROM and grip strength improved significantly. Pain was eliminated in 34 patients but was present in strenuous activities in cases of SSA. All patients returned to their previous occupation within 4-6 months. Discussion and Conclusions: VBG lead to rapid and successful healing with reconstruction of length and angulation. The choice of the most suitable VBG depends on the location of the nonunion. An additional procedure is necessary for cases with established SSA.
109. PALMAR SCAPHOID
VASCULARIZED NONUNION
BONE
GRAFTS
FOR
Max Haerle I, G. Vandeputte’, Ch. Mathoulin*. ‘Hand & Plastic Surgery, Bg Clinic, University of Tiibingen, Tiibingen, Germany: ‘Institut de la Main, Paris, France Introduction: We analyzed the results of 94 scaphoid non-unions treated with a vascularized bone graft from the distal palmar radius. The grafts are vascularized by the palmar carpal artery. Material: There were 15 female and 79 male patients, 41 left and 53 right wrists. The mean age at surgery was 30.6 years (range 15-61). Results: Median radiographic evidence of union was achieved after 8.0 weeks (range 5-24~) in 84 patients (89%). Overall there was a slight increase in range of motion postoperatively. Patients noted a significant decrease in pain postoperatively (p < 0.0017). The functional result was graded as excellent in 54 cases, good in 20 cases, fair in 13 cases and poor in 5 cases. Statistical analysis as bivariate and multivariate correlations were calculated and will be discussed. Discussion. There was a clear correlation between the stage of pseudarthrosis and the final outcome of surgery, best results were
THE JOURNAL
OF HAND
SURGERY
VOL. 28B SUPPLEMENT
obtained in patients with stage 2A in Alnot’s classification. The use of a vascularized bone graft harvested from the palmar aspect of the radius often results in union of scaphoid nonunion.
110. PROXIMAL APPROACH
ROW
CARPECTOMY
THROUGH
57
I
VOLAR
Giorgio Pilato, A. Bini, F. Baldo, L. Murena. Institute qf Orthopaedics and Trauma “M. Boni”, Viale Borri 57, 2110: Varese, Ital) Proximal Row Carpectomy (PRC) has been utilized mainly in post-traumatic wrist conditions to relieve pain and restore stability while preserving motion. The use of volar approach to perform PRC has been reported to markedly improve functional and to wrist motion compared with the results of dorsal approach. We have performed PRC through a volar approach in eight patients with diagnosis of Kienbiick’s disease (Lichtman BIB) in one case, and radio-scaphoid degenerative arthritis in seven cases. Results at an average follow-up of 20 months (12-42) show relief of pain in six cases with one patient reporting mild pain after wrist exertion and one complaining of moderate pain in daily activities. Average range of motion was 57” flexion, 43” extension, 3 1’ ulnar deviation and 7” radial deviation, with total flexion-extension arc attaining 76% of opposite wrist. Grip strength was 78% of contralateral wrist. X-rays did not’t show any degenerative changes of the new radio-capitate joint. We conclude that PRC through volar approach allows better functional results than dorsal approach on comparison of improvement of range of motion; compliance of the patient to the rehabilitation programme is mandatory to improve results; longer follow-up is needed to evaluate the ultimate outcome of the new radio-capitate joint.
111. TEN YEARS OF PROXIMAL ROW CARPECTOMY THROUGH A PALMAR APPROACH RICCARDO LUCHETTI DEPARTMENT OF SURGERY FOR THE HAND, STATE HOSPITAL OF SAN MARINO, VIA PIETRO DA RIMINI 4,479OO RIMINI, 4790 RIMINI, ITALY
Andrea Atzei. Department of Surgery for the Hand, Policlinico Borgo Roma. Verow Italy Introduction: From 1990 to 2000, 30 proximal row carpectomies on 29 patients were done through a palmar approach. METHODS All the patients were evaluated preop and postop according to clinical and radiological parameters. Mayo Wrist Score and DASH Questionnaire were also included. Results: With an average follow-up of 58 months, 26 cases (23 males and 3 females with an average age of 35 years) were evaluated. Preop-postop data were: Pain from 8 to 1; Flex/Ext from 85 to 94; Radial/Ulnar Dev from 39 to 46; Grip Strength (kg) from 22 to 33. The X-ray findings (reduction in articular space and subchondral sclerosis in radiocapitate articulation) were: 5 normal, 5 mild, 9 moderate, 6 fair. No statistical significant correlation was find with clinical outcome. Cineradiography confirmed complete stability of the new articulation during movements of AP and PA stressing, flexionlextension and radial/ulnar wrist deviation.
Nineteen per cent of the patients returned to the previous work within 2 months on average. Discussion and conclusion: We consider that the results following PRC through a palmar approach are satisfactory in terms of rendering the wrist painless, maintaining functional wrist mobility, improving grip strength and allowing return to work.
112. RADIOSCAPHOLUNATE FUSION + DISTAL SCAPHOIDECTOMY FOR THE TREATMENT OF RADIOCARPAL ARTHROSIS Marc Garcia-Elias ‘, Albert0 L. Lluch2. ‘Passe& de la Bonanova, 9, 2” 2’, 08022 Barcelona, Spain; ‘Institut Kaplan, Barcelona, Spain Purpose of the study: Cornminuted articular fractures of the distal radius leaving permanent damage to the radiocarpal cartilage is a condition often treated by a radioscapholunate (RSL) arthrodesis. Once fused to the radius, however, the scaphoid becomes a fixed static constant to the distal row, preventing this to full flexion and/or radial deviation. Any attempt of the distal row to move towards the radial side is likely to increase the stress within the STT joint, making for the development of secondary degeneration at this level. We hypothesized that by adding a distal scaphoidectomy to RSL fusions, the long term results would improve as a consequence of the “ball-and-socket” central component of the midcarpal joint being freed from lateral constrains. Patients and methods: A prospective study of 13 patients (10 male, 3 female; avg: 46 years old, from 22 to 65 years) with post-traumatic degeneration of the radiocarpal joint, were treated by associating a distal scaphoid resection to a regular RSL fusion. The patients have been followed up at an average of 23 months (12-70 months) post surgery. Results: All patients are very satisfied (average: 9.3 in a scale of visual analog scale from 0 tolO), with only some discomfort at the extremes of the retained motion in 5. All, except one who retired, went back to their usual activities. As the radiocarpal joint is fixed and the only motion occurs at the midcarpal level, the overall plane of flexion-extension appears somewhat tilted towards the so-called “dart-throwing” plane of rotation. Wrist flexion-ulnar deviation: 37 f 13” and wrist extension-radial deviation:34 It 22”. Such an oblique plane of motion, however, was not regarded as a problem by the patients, as they considered this quite useful in activities of daily living. Average grip strength: 86% of the contralateral, unaffected side. Conclusion: By adding a distal scaphoidectomy, the average range of rotation obtained in this series (7 1 degrees) appears substantially larger than the 47” reported by Sturzenegger and Biichler ]I] with only a RSL fusion, without the negative consequence of developing an STT arthritis. Therefore, distal scaphoidectomy is recommended in all cases where a badly damaged radiocarpal joint needs to be fused. Reference: [l] Sturzenegger M, Btichler U. Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius. Ann Chir Main Memb Sup 10:207-216. 1991.