title: Stage III Advanced Wrist Collapse Treatment Options: A Cadaveric Study.
abstract: BackgroundScapholunate advanced collapse and scaphoid nonunion advanced collapse result in high morbidity and pose significant challenges for active patients. Multiple treatment options have been proposed to yield satisfactory results; however, restoration of physiological wrist motion remains an issue.Questions/PurposesThe objective of this study was to compare wrist mobility after four different treatment methods for grade III wrist collapse: (1) no treatment, (2) scaphoidectomy and lunate-capitate arthrodesis, (3) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum-hamate arthrodesis, and (4) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum excision.MethodsFour paired (n= 8) fresh-frozen human cadaveric upper limbs were used in this controlled laboratory study. Computed tomography scans were collected at all testing states and measurements were made to evaluate midcarpal joint mobility and alignment.ResultsA significant decrease in wrist extension was observed for all treatments. Middle column and two-column arthrodesis demonstrated no significant differences for carpal alignment and mobility. No significant differences were observed for triquetrum-hamate mobility or wrist extension between the partial and two-column arthrodesis. Triquetrum excision significantly improved ulnar deviation.ConclusionThe most important finding of this study was that the one-column arthrodesis has comparable carpal alignment and range of motion to that of bi-column arthrodesis.Clinical RelevanceThe results of this study suggest that a stage III advanced wrist collapse can be treated by isolated lunate-capitate arthrodesis with scaphoidectomy. Fusion between the remaining carpal bones may not be necessary because the carpal alignment and range of motion of the remaining joints were not significantly different in the present study.
authors: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado.
authors: Jorge
authors: J
authors: Chahla
authors: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado.
authors: Jason M
authors: JM
authors: Schon
authors: Upper Extremity and Hand Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors: Ramiro
authors: R
authors: Olleac
authors: Upper Extremity and Hand Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors: Sebastián
authors: S
authors: Senes
authors: Upper Extremity and Hand Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors: Damián
authors: D
authors: Arroquy
authors: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado.
authors: Chase S
authors: CS
authors: Dean
authors: Upper Extremity and Hand Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors: Gabriel
authors: G
authors: Clembosky
authors: Upper Extremity and Hand Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
authors: Alvaro
authors: A
authors: Muratore
keywords: advanced collapse; arthritis; biomechanics; scaphoid nonunion advanced collapse; wrist