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Scaphoid Excision and Bicolumnar Carpal Fusion with Retrograde Headless Screws
Sebastian Undurraga1, Kendrick Au2, Johanna Dobransky3
1Unidad de Mano Departamento de Traumatología Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Journal of Wrist Surgery
|June 10, 2021
Summary
This study shows that bicolumnar wrist fusion using headless screws effectively treats wrist arthritis, preserving joint function and strength. Midterm outcomes demonstrate good range of motion and grip strength, with potential benefits for specific fusion angles.
Area of Science:
- Orthopedic Surgery
- Hand and Wrist Surgery
- Arthritis Treatment
Background:
- Scaphoid excision and partial wrist fusion are indicated for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist arthritis.
- Bicolumnar fusion targets the lunocapitate and triquetrohamate joints for improved wrist stability and function.
Purpose of the Study:
- To evaluate midterm functional and radiographic outcomes of bicolumnar wrist fusion using retrograde headless screws.
- To assess patient-reported outcomes and functional recovery after this surgical technique.
Main Methods:
- Twenty-three patients (25 wrists) underwent bicolumnar fusion with retrograde headless screws.
- Evaluated range of motion, grip/pinch strength, DASH, and PRWE scores.
- Radiographic assessment included fusion rates and capitolunate angle; correlation with wrist motion was analyzed.
Main Results:
- Average follow-up was 18 months with functional wrist motion (extension 41°, flexion 36°, deviation 43°).
- Grip strength (39kg) and pinch strength (9kg) were near normal; patient-reported scores (DASH 19, PRWE 28) indicated moderate outcomes.
- An extended capitolunate fusion angle trended towards increased wrist extension, but lacked statistical significance (p=0.17).
Conclusions:
- Retrograde headless screws preserve the lunate's articular surface, maintaining load-bearing capacity.
- Bicolumnar fusion provides a functional arc of motion and near-normal grip/pinch strength.
- Further research is needed to confirm if a capitolunate fusion angle >20° enhances wrist extension.
