title: Results after radioscapholunate arthrodesis with or without resection of the distal scaphoid pole.
abstract: OBJECTIVE
  To evaluate the differences between radioscapholunate (RSL) arthrodesis alone versus RSL arthrodesis with additional distal scaphoidectomy.
  
  
  METHODS
  We retrospectively evaluated 61 patients who were treated with RSL arthrodesis for painful posttraumatic osteoarthritis. Thirty patients had an RSL arthrodesis with additional resection of the distal scaphoid pole (group A), and 31 had RSL arthrodesis alone (group B). Six patients in group A and 8 in group B had the RSL arthrodesis converted to a complete wrist arthrodesis during follow-up. Those patients were excluded from the survey. Of the remaining 47 patients, 35 (20 from group A, 15 from group B) returned for a clinical and radiological examination at an average of 28 (range, 10-47) months after the index surgery. The results were rated by the Disabilities of the Arm, Shoulder, and Hand score and the modified Mayo Wrist Score. The patients' outcomes after RSL arthrodesis with or without distal scaphoidectomy were compared for pain, wrist motion, grip strength, nonunion rate, osteoarthritis of the adjacent joints, the Disabilities of the Arm, Shoulder, and Hand score and the modified Mayo Wrist Score.
  
  
  RESULTS
  Three patients with RSL arthrodesis alone showed a radioscaphoid nonunion. All arthrodeses in group A healed. In the clinical evaluation, there was no significant difference between groups A and B in the Disabilities of the Arm, Shoulder, and Hand score, the modified Mayo Wrist Score, grip strength, pain, or wrist motion. Assuming that wrist motion might be better in patients with a nonunion, the average wrist motion was recalculated after eliminating 3 patients with a radioscaphoid nonunion from group B. Radial deviation was then found to be significantly better in group A.
  
  
  CONCLUSIONS
  Additional distal scaphoidectomy with RSL arthrodesis seems to improve postoperative radial deviation of the wrist. The radioscaphoid nonunion rate is high with RSL arthrodesis alone. Distal scaphoidectomy appeared to increase the successful fusion rate of RSL arthrodeses. No significant effect on wrist extension, flexion, ulnar deviation, pain level, restriction in activities of daily living, or grip strength was noted.
authors.affiliation: Clinic for Hand Surgery, Bad Neustadt/Saale, Germany. muehldorfer3@gmx.de
authors.forename: Marion
authors.initials: M
authors.lastname: Mühldorfer-Fodor
authors.forename: Hue Phan
authors.initials: HP
authors.lastname: Ha
authors.forename: Bernd
authors.initials: B
authors.lastname: Hohendorff
authors.forename: Steffen
authors.initials: S
authors.lastname: Löw
authors.forename: Karl Josef
authors.initials: KJ
authors.lastname: Prommersberger
authors.forename: Jörg
authors.initials: J
authors.lastname: van Schoonhoven
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D002348:Carpal Bones / Q000601:surgery*; D005260:Female; D018737:Hand Strength; D006801:Humans; D012667:Lunate Bone / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D011884:Radius / Q000601:surgery; D011885:Radius Fractures / Q000150:complications; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology