[Osteocartilaginous autograft after proximal resection of the scaphoid for radioscaphoid osteoarthritis].
OBJECTIVE
Radioscaphoid osteoarthritis is usually a complication of scaphoid pseudarthrosis or chronic scapholunate disjunction. As an alternative to the classical surgical techniques used for this lesion, we propose a novel reconstruction method consisting In partial proximal resection of the scaphoid associated with interposition of a biological spacer composed of a osteocartilaginous rib graft. The purpose of this study was to present the technical aspects of this procedure and to report preliminary results in ten patients with radioscapular osteoarthritis treated between 1994 and 2001.


METHODS
We performed a retrospective analysis of the ten patients who underwent surgery from 1994 to 2001 for early-stage radioscaphoid osteoarthritis associated with scaphoid osteoarthritis in eight and chronic scapholunate disjunction in two. The procedure consisted in partial resection of the proximal portion of the scaphoid and insertion of an osteocartilaginous autograft harvested from a rib. Outcome was based on the clinical results (pain, motion, grip force, activity) and patient satisfaction. Bone healing was measured with plain x-rays and vitality of the osteocartilaginous graft with MRI.


RESULTS
Mean follow-up was 4.6 years. Clinical outcome was considered excellent or good in eight patients, fair in one and poor in one (graft dislocation). All patients were satisfied or very satisfied except one (one failure). Radiological healing was achieved at three months in nine patients. Four patients underwent an MRI examination at thirteen months which demonstrated, in all patients: no sign of necrosis, healing of the graft-scaphoid interface, and no bony metaplasia in the cartilage.


CONCLUSIONS
Compared with partial carpal arthrodesis and resection of the first row of the carpus, this palliative technique can be used to reconstruct the proximal portion of the carpal scaphoid in young patients with early-stage radioscaphoid osteoarthritis. As for arthroplasty or scaphoid implants, our goal was to achieve a satisfactory scaphoid height using a biological spacer after resection of the proximal 3/4 of the bone. The results of this technique are encouraging but must be examined with precaution due to the small number of patients and the short follow-up to date.
Lepage
D
D
Service de Traumatologie-Orthopédie et Chirurgie Plastique et Reconstructrice, CHU Jean-Minjoz, 4, boulevard Flemming, 25030 Besançon. dlepage@chu-besancon.fr
Obert
L
L
Clappaz
P
P
Hampel
C
C
Garbuio
P
P
Tropet
Y
Y
D000328:Adult; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012272:Ribs / Q000637:transplantation; D021361:Scaphoid Bone / Q000601:surgery*; D016896:Treatment Outcome