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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Arthroscopic Scaphoid Excision and 4-corner Fusion of Scaphoid Nonunion Advanced Collapse or Scapho-lunate Advanced Collapse Wrist

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  • presenting/speaker Jae Woo Shim - Samsung Medical Center, Seoul, South Korea
  • Min Jong Park - Samsung Medical Center, Seoul, South Korea
  • Hyeon Lee - Samsung Medical Center, Seoul, South Korea
  • Joo Hwan Kim - Samsung Medical Center, Seoul, South Korea
  • Young Taek Chae - Samsung Medical Center, Seoul, South Korea
  • Hee Seol Park - Samsung Medical Center, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1008

doi: 10.3205/19ifssh0825, urn:nbn:de:0183-19ifssh08255

Published: February 6, 2020

© 2020 Shim et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Arthroscopic scaphoid excision and 4-corner fusion is a minimally invasive procedure that can be expected to achieve rapid bone union and recovery. The purpose of this study is to report the results of arthroscopic scaphoid excision and 4-corner fusion.

Methods: A total of 14 patients with arthroscopic scaphoid excision and 4-corner fusion from 2011 to 2016 were reviewed retrospectively. The patients with scaphoid nonunion advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC) stage 2 or higher were included. Scaphoid excision and decortication for 4-corner fusion were performed with arthroscopic assistance. After arthroscopic procedure, dorsal intercalated segment instability (DISI) deformity was corrected and headless auto-compressive screws were inserted through capitate-lunate and triquetrum-hamate-capitate by percutaneous method. Bone union and DISI deformity were evaluated by radiographs. Preoperative and postoperative pain Visual Analogue Scale (pVAS), range of motion (ROM), grip strength, the Modified Mayo Wrist Score (MMWS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score were analyzed.

Results and Conclusions: There were 11 male and 3 female patients, with an average age of 58 years (range, 32-77 years). There were 12 SNAC patients and 2 SLAC patients. The mean follow-up period was 26.0 months (range, 24-34 months). Bone union was observed in 13 patients after mean 8.3 weeks (range, 5-12 weeks). One patient did not show a bony union, but was maintained without symptoms. It was thought to be a stable fibrous union and was observed without additional treatment. There were no other major complications related to surgery. The capitate-lunate angle was significantly reduced from 13.7° preoperatively to 4.1° postoperatively (p<0.001). The flexion-extension arc showed no significant change from 83° preoperatively to 76° postoperatively. The grip strength showed no significant change from 53 lb preoperatively to 56 lb postoperatively. The pVAS, MMWS, and DASH score were significantly improved from 5.1, 56, and 43.3 to 1.3, 69, and 16.1, respectively (p<0.001).

Arthroscopic scaphoid excision and 4-corner fusion showed rapid bone union and good clinical outcomes without major complications.