Resection of the distal pole of the scaphoid for scaphoid nonunion with radioscaphoid and intercarpal arthritis.
OBJECTIVE
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 degrees (51.4% of the opposite wrist) to 140 degrees (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.
Soejima
Osamu
O
Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
Iida
Hiroyuki
H
Hanamura
Tatuo
T
Naito
Masatoshi
M
D000328:Adult; D000368:Aged; D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology; D012086:Reoperation; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*