Range of motion effects of distal pole scaphoid excision and triquetral excision after radioscapholunate fusion: a cadaver study.
OBJECTIVE
Radioscapholunate (RSL) fusion is an effective surgical procedure for the treatment of isolated radiocarpal arthritis. Although functional wrist motion is typically preserved through the midcarpal joint, many patients are still frustrated by postoperative limitations. The purpose of this study was to evaluate motion of cadaver wrists after simulated RSL fusion with excision of the distal pole of the scaphoid and the triquetrum.


METHODS
Ten fresh-frozen cadaver upper extremities were mounted on a custom testing apparatus after isolation of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis longus, and extensor carpi ulnaris tendons. Sequential loading of these tendons resulted in flexion, extension, radial, and ulnar deviation. We subsequently measured range of motion with the use of digital photography. All specimens were tested in 4 states: intact (normal), RSL fusion (simulated), RSL fusion with distal scaphoid pole excision, and RSL fusion with distal scaphoid pole and triquetrum excision. The results were statistically analyzed using a repeated measures analysis of variance.


RESULTS
Range of motion decreased to 39% to 46% of normal for flexion and extension and 65% to 71% of normal for radial and ulnar deviation after simulated RSL fusion. The addition of distal pole of scaphoid excision resulted in flexion and extension returning to 72% to 79% of normal, and radial and ulnar deviation returning to 84% to 89% of normal. Excision of the triquetrum further increased flexion and extension to 87% to 97% of normal, and radial and ulnar deviation to 119% to 137% of normal.


CONCLUSIONS
The combination of triquetral and distal scaphoid pole excision after RSL fusion improves wrist motion to levels close to normal in the cadaver model.
Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia 23284-3067, USA.
Khurram
K
Pervaiz
William H
WH
Bowers
Jonathan E
JE
Isaacs
John R
JR
Owen
Jennifer S
JS
Wayne
D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis; D001696:Biomechanical Phenomena; D001864:Bone Wires; D005260:Female; D006801:Humans; D012667:Lunate Bone / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D011884:Radius / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D021361:Scaphoid Bone / Q000503:physiopathology / Q000601:surgery*; D051221:Triquetrum Bone / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery