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Carpal alignment after different surgical approaches to the scaphoid: a comparative study
M Garcia-Elias1, A Vall, J M Salo
1Department of Orthopaedic Surgery, Hospital de Sant Joan de Déu, Manresa, Spain.
The Journal of Hand Surgery
|July 1, 1988
Summary
For scaphoid nonunion bone grafting, the dorsal surgical approach is preferable. It maintains carpal alignment, unlike the palmar approach which can lead to carpal collapse.
Area of Science:
- Orthopedic surgery
- Hand surgery
- Bone grafting
Background:
- Scaphoid nonunion is a common complication following wrist fractures.
- Inlay bone grafting is a surgical technique used to treat scaphoid nonunion.
- The choice of surgical approach (palmar vs. dorsal) may impact wrist function and carpal alignment.
Purpose of the Study:
- To compare the outcomes of palmar and dorsal approaches for inlay bone grafting in scaphoid nonunion.
- To evaluate the effect of each surgical approach on wrist function and carpal alignment.
Main Methods:
- Retrospective evaluation of 37 patients undergoing inlay bone grafting for scaphoid nonunion.
- Patients were divided into two groups based on surgical approach: palmar (n=26) or dorsal (n=11).
- Pre- and post-operative assessment of wrist function and carpal alignment (scapholunate and lunocapitate angles).
Main Results:
- Both palmar and dorsal approaches demonstrated similar union rates (approximately 80%).
- The palmar approach resulted in a significant increase in scapholunate angle (p<0.001) and lunocapitate angle (p<0.05), indicating carpal collapse.
- The dorsal approach did not significantly alter carpal alignment.
Conclusions:
- The dorsal approach for inlay bone grafting in scaphoid nonunion is associated with better maintenance of carpal alignment compared to the palmar approach.
- Division of palmar radiocarpal ligaments during the palmar approach may contribute to carpal instability.
- A dorsal approach is recommended for inlay bone grafting in scaphoid nonunion to preserve carpal alignment.