gms | German Medical Science

Objectives/Interrogation: Scaphoid resection and arthrodesis of the midcarpal joint is traditionally performed from an open dorsal arthrotomy. More recently an arthroscopic procedure has been introduced. The artroscopic approach is time-consuming and technically challenging. We wanted to find out the incidence of complications during the learning phase in a single surgeon case series.

Methods: We retrospectively identified 8 patients with 9 cases of arthroscopic scaphoidectomy and midcarpal arthrodesis (6 cases of scapholunate advanced collapse, one case each of Preiser disease, radioscaphoid or capitolunar osteoarthritis) in 2014-2017. All patients were operated by the same surgeon (Level of expertice 3; >10 years of experience in wrist arthroscopy) [1]. Osteosynthesis was performed with cannulated screws placed under fluoroscopic guidance. The follow-up time was 5-14 months.

Results and Conclusions: The operating time for the first surgery was 198 minutes. For the last surgery in the series, the operating time was 132 minutes. Fusion was achieved in all patients. Three (33%) patients required a reoperation: scaphoid remnant removal for impingement and two cases of screw removal due to screw malposition. In one of the latter cases a tendon repair was also performed due to tendon laceration caused by a retracted screw. One patient suffered a superfical radial nerve injury.

There is a steep learning curve associated with demanding arthroscopic procedures. We observed a high rate of complications and reoperations among patients operated by an experienced and motivated wrist surgeon. Some of the findings of this study should be taken into consideration when arthroscopic wrist fusion is adopted in an institution for the first time. Performing both total scaphoidectomy and the midcarpal arthrodesis via arthroscopy may lead to long operating times in the first procedures, but the operating time will eventually decrease. It is an option to perform an open scaphoidectomy from a volar incision in the first procedures to reduce operative time, but this was not utilized in this series. To avoid complications relating to hardware, we recommend special attention to the placement of the cannulated screws. Meticulous removal of the scaphoid may reduce the risk of impingement. A structured wrist surgeon training protocol with live surgical demonstrations might be useful in reducing complications.