gms | German Medical Science

Objectives: Especially in patients with a scaphoid nonunion and preoperative minor symptoms scaphoid nonunion surgery is considered to prevent osteoarthritis. However, we know surgery does not prevent progressive wrist osteoarthritis in all patients and osteoarthritis does not always result in complaints. During preoperative counseling it is important to weigh the chances of postoperative worsening for these patients against developing wrist osteoarthritis. To assess disadvantages of surgery, we aim to evaluate the amount of patients with preoperative minor symptoms that reported postoperative worse outcomes.

Method: We performed a cohort study where data was prospectively collected as part of usual care. Adult patients with a scaphoid nonunion and preoperative minor symptoms who underwent non-salvage surgery were included if the postoperative Patient Rated Wrist/Hand evaluation (PRWHE) was available. Patients were classified with minor symptoms based on a preoperative PRWHE score of maximally 30. We assessed impairment during patient-specific activities with the patient specific functional scale (PSFS). Our primary outcome was the percentage of patients that reported postoperative worse functional outcome which was a clinically relevant worse postoperative physical functioning and pain (PRWHE score) reaching the minimally clinically important difference. As secondary outcomes we evaluated patient satisfaction and the amount of reoperations.

Results: Of the 35 included patients with preoperative minor symptoms, several patients reported problems with patient-specific activities as recreation and leisure, work and employment and changing body position. A worse postoperative functional outcome was reported by 9% [95% CI 3 to 17] of the patients, 34% [95% CI 21 to 51] of the patients was not satisfied with the treatment result, and 23% [95% CI 12 to 39] would not undergo the treatment again under similar circumstances. A reoperation (screw removal, revision surgery and salvage procedure) was performed in 9% of the patients.

Conclusion: The risk of having postoperative worse functional outcome (9%), being unsatisfied after the treatment (34%), and the need for a reoperation (9%) should be weighted with the experienced impairment in daily life, the ability to adapt activities and the chances of developing wrist osteoarthritis during preoperative counseling.