RETROSPECTIVE ANALYSIS OF 13 CASES OF SCAPHOCAPITATUM ARTHRODESIS FRO THE TREATMENT OF POSTTRAUMATIC SCAPHOLUNATE SPRAIN

Abstract

Purpose of the study: Appropriate management of chronic sprains of the scapholunate joint remains a subject of debate. Different surgical techniques have been proposed, from partial arthrodesis of the carpus to ligamentoplasty. We opted for scaphocapitatum arthrodesis. The purpose of this report was to assess clinical and radiological outcome.

Material and methods: From 1997 to 2001, 13 arthrodeses (13 patients) were performed for this indication. The procedure involved two screws (n=11), one screw and stapling (n=1), and stapling alone (n=1). A free autologous graft was used in all cases. Mean patient age was 40 years (12 males and one female). These patients were victims of sports accidents (n=8) or occupational accidents (n=5). Mean follow-up was 26 months (range 24–31 months). Variables noted were joint mobility, pain, grasp force and pinch force. Wrist x-rays were used to measure the height of the carpus and the radio-lunate angle.

Results: A 31% loss in the radial inclination was noted as as a 14.5% loss in the ulnar inclination. Dorsal flexion of the wrist declined from 60° to 48°, palmar flexion from 47° to 28°. Stiffness mainly involved the radial inclination and palmar flexion. Grasp and Pinch forces improved (125° on average). All patients excep one presented residual pain. Six patients complained of pain only for efforts and six presented invalidating pain. Only seven patients were able to resume their occupational activity. There were three cases of nonunion which required revision to achieve final bone healing (poor outcome). Carpal height improved (0.47±0.54). The mean radiolunate angle at last follow-up was 11°. DISI persisted in only one wrist.

Discussion: This technique reduced wrist mobility. For all patients, the dorsal approach to the wrist produced inevitable stiffness. Radial inclination declines due to the intracarpal fusion. This arthrodesis enabled restitution of the carpal height and partially corrected for the DISI. This operation did not provide pain relief but did not alter the carpal x-ray. We raise the question of the pertinence of associating this type of arthrodesis with total denervation of the wrist.