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Distal scaphoid excision after radioscaphoid arthrodesis
D McCombe1, D C Ireland, I McNab
1Bernard O'Brien Institute of Microsurgery, St Vincent's Hospital, Melbourne, Australia.
The Journal of Hand Surgery
|September 19, 2001
Summary
Adding distal scaphoid excision to radioscaphoid arthrodesis significantly improves wrist motion. This surgical modification addresses the major limitation of restricted movement in wrist arthritis treatment.
Area of Science:
- Orthopedic Surgery
- Hand and Wrist Surgery
- Biomechanical Studies
Background:
- Radioscaphoid and radioscapholunate arthrodeses are established treatments for radiocarpal arthritis.
- A significant limitation of these procedures is the substantial restriction of wrist motion due to scaphoid immobilization.
Purpose of the Study:
- To evaluate the effect of distal scaphoid excision on wrist range of motion following radioscaphoid arthrodesis in a cadaver model.
- To determine if this modification can mitigate the motion-limiting effects of current arthrodesis techniques.
Main Methods:
- A cadaveric study was performed involving radioscaphoid arthrodesis using K-wire fixation.
- Range of motion was measured before and after the procedure.
- Distal scaphoid excision was subsequently performed with K-wires remaining in place, and range of motion was reassessed.
Main Results:
- Radioscaphoid arthrodesis alone resulted in a 58% decrease in the flexion-extension arc.
- Following distal scaphoid excision, the flexion-extension arc increased to 86% of the preoperative range.
- The majority of motion recovery was observed at the midcarpal joint.
Conclusions:
- Distal scaphoid excision effectively releases the midcarpal joint after radioscaphoid fixation.
- This technique significantly enhances wrist motion compared to radioscaphoid arthrodesis alone.
- Clinical application of this modification could address the primary limitation of restricted motion in wrist arthrodesis procedures.