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Simple Excision of Proximal Scaphoid Nonunion: A Viable Option When the Scapholunate Ligament Is Intact
Ana Scott-Tennent De Rivas1, Pau Forcada Calvet2, Mireia Esplugas Mimó3
1Hospital Universitari Arnau de Vilanova, Lleida, Spain; Hospital Universitari Santa Maria, Lleida, Spain; Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Grupo multidisciplinar de investigación clínica en patología musculoesquelética, fragilidad y tratamiento del dolor, Instituto de Investigación Biomédica, Lleida, Spain.
Purpose:
Because of the biological, anatomical, and biomechanical characteristics of the scaphoid, treating some proximal pole nonunions remains challenging. The location of the nonunion (proximal or distal to the dorsal apex) may influence its natural history. Based on this concept, patients with a proximal pole nonunion located proximal to the dorsal apex and maintaining an intact insertion of the dorsal scapholunate ligament in the distal fragment of the scaphoid may benefit from simple excision of the proximal pole. This study evaluated the clinical and functional outcomes of this treatment approach.
Methods:
A retrospective review was conducted on 11 patients who underwent simple excision of the proximal pole fragment as treatment for proximal pole scaphoid nonunion in which the scapholunate interosseous ligament remained attached to the distal fragment. Postoperative outcomes included pain, range of motion, grip strength, and patient-reported outcome measures, including the Patient-Rated Wrist Evaluation, Patient-Specific Functional Scale, and EQ-5D. Patient satisfaction and return-to-work rates were also analyzed.
Results:
Postoperative pain, Patient-Rated Wrist Evaluation, Patient-Specific Functional Scale, and EQ-5D scores improved after surgery. Ten of 11 patients returned to their previous occupational activities. Four patients reported dorsoradial discomfort, but only one underwent surgical revision for radial styloidectomy. No radiological progression to a scaphoid nonunion advanced collapse pattern or other complications were observed.
Conclusions:
These findings support that proximal pole simple excision is a viable and relatively simple treatment for a subset of proximal pole scaphoid nonunion in which the proximal fragment is nonviable and a competent dorsal scapholunate ligament remains inserted in the distal fragment.
Type Of Study/Level Of Evidence:
Therapeutic IV.
