Capitate sliding osteotomy combined with lunocapitate fusion for stage II/III scaphoid non-union advanced collapse

Although lunocapitate fusion is currently the most prevalent and effective surgical approach for stage II/III scaphoid non-union advanced collapse (SNAC), clinical challenges such as suboptimal fusion rates and compromised wrist functionality remain unresolved. This study aims to investigate the application of capitate sliding osteotomy combined with central and eccentric fixation techniques in lunocapitate fusion, with the dual objectives of enhancing fusion rates and enabling rigid fixation to facilitate early postoperative rehabilitation, thereby improving postoperative functional outcomes.

We retrospectively analyzed patients who underwent lunocapitate fusion combined with capitate sliding osteotomy (treatment group) and those who underwent lunocapitate fusion alone (control group) between 2016 and 2024. The average follow-up period was approximately 24 months. These assessments were conducted systematically using various measures, including the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist flexion-extension range of motion (ROM), visual analogue scale (VAS) score for pain, and grip strength measurements, preoperatively and at postoperative follow-up assessments.

The treatment group demonstrated significantly superior outcomes compared with the control group at final follow-up. DASH scores improved from 53.91 ± 5.75 preoperatively to 10.73 ± 5.52 postoperatively in the treatment group vs. 51.57 ± 3.94-20.05 ± 3.61 in the control group (p < 0.001). VAS pain scores decreased from 5.72 ± 0.87 to 0.71 ± 0.22 in the treatment group vs. 5.38 ± 0.70-1.23 ± 0.25 in the control group (p < 0.001). Wrist flexion-extension ROM improved from 80.49° ± 3.36° to 113.74° ± 3.76° in the treatment group vs. 82.54° ± 3.85°-107.25° ± 4.80° in the control group (p < 0.001). Grip strength increased from 12.24 ± 1.47 kg to 29.27 ± 2.32 kg in the treatment group vs. 13.53 ± 2.94 kg to 25.56 ± 2.32 kg in the control group (p < 0.001). All patients in the treatment group achieved solid fusion.

In this retrospective comparative study, the combination of capitate sliding osteotomy with lunocapitate fusion was associated with higher fusion rates and greater improvements in short-term functional outcomes compared with lunocapitate fusion alone for stage II/III SNAC. This technique appears to be a promising option that may allow for earlier rehabilitation.