gms | German Medical Science

Objectives/Interrogation: Recessed arthrodesis of the radiocarpal joint with distal scaphoid hemi resection can reduce pain and provide functional motion through the mid carpal joint.

Methods: 27 patients with advanced radiocarpal arthritis (11 patients following failed treatment of complex distal radius fractures, 8 patients with scapholunate advanced collapse, 4 patients with scaphoid nonunion with advanced collapse and 4 patients following failure of treatment for transcaphoid perilunate fracture dislocation) were treated with a procedure to recess the lunate and proximal pole of scaphoid into the metaphyseal bone of the distal radius, resection of the distal one half of the scaphoid was also performed to allow enhanced motion of the capitate head within the midcarpal joint as a "universal joint". Fixation of the lunate and proximal scaphoid was achieved through flexible tension plates. Controlled early active motion was begun one week after surgery (patients have been followed for an average of 6.8 years, range 2-14 years).

Results and Conclusions: All 27 patients developed a stable union at the arthrodesis site. None had hardware problems and there were no infections. Range of motion increased from an average preoperative total arc of flexion-extension of 32 to a total arc of flexion extension of 68 (range 42 to 110). Pain ratings on a visual analog scale decreased from an average of 8.7 to 1.2. Twenty-five of 27 patients demonstrated significant increase ability in their activities of daily living. One patient had persistent stiffness and was not pleased with his limited motion but had significant pain relief. One patient developed mid carpal arthritis and was converted to a total wrist arthroplasty.

Scaphoid hemi resection and limited arthrodesis of the radio-carpal joint is a viable motion sparing procedure for isolated radiocarpal arthritis. Although there are limitations in the total degree of movement, the motion which persists is functional, pain relief has been substantial and the long-term (4-16 yr) follow-up suggests minimal deterioration. This procedure is technically straight forward and appears to be a viable alternative to total wrist arthrodesis when the mid carpal joint is reasonably spared. Revision to total wrist arthroplasty remains a viable salvageable procedure.