title: Corrective osteotomy for scaphoid malunion: technique and long-term follow-up evaluation.
abstract: Five patients with dorsal intercalated segment instability underwent corrective osteotomy for symptomatic scaphoid malunion. Follow-up examination at an average of nearly 9 years after the procedure (range, 1.5-19 years) revealed that all had improvement in range of motion (ROM). Total active ROM improved from a mean of 127 degrees (range, 95 degrees-165 degrees) to a mean of 156 degrees (range, 95 degrees-214 degrees). Grip strength increased from a mean of 16 kg (range, 14-35 kg) to a mean of 32 kg (range, 24-48 kg). The wrist score improved from an average of 19 to 75. The preoperative intrascaphoid and carpal malalignments were reduced, as demonstrated by trispiral tomography. Symptomatically, all patients reported improvement. All osteotomies healed within 5.5 months of the procedure. No case of avascular necrosis was noted. Mild radioscaphoid arthrosis is apparent in four patients and a preexisting midcarpal arthrosis persists in one patient. Corrective osteotomy for scaphoid malunion may have a role in the prevention or slowing of the onset of premature arthritis in young patients with high functional demands. A technique is described.
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: N M
authors.initials: NM
authors.lastname: Lynch
authors.forename: R L
authors.initials: RL
authors.lastname: Linscheid
mesh_terms: D000328:Adult; D001168:Arthritis / Q000209:etiology; D016025:Bone Transplantation; D001864:Bone Wires; D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D002370:Casts, Surgical; D005500:Follow-Up Studies; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D010020:Osteonecrosis / Q000209:etiology; D010027:Osteotomy; D016059:Range of Motion, Articular; D014056:Tomography, X-Ray; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery