Postsurgical Carpal Collapse Following Scaphoidectomy With Partial Wrist Fusion: A Retrospective Radiographic Study

To evaluate radiographic postsurgical carpal collapse (PSCC) following scaphoidectomy with partial wrist fusion and identify patient and surgical factors associated with progressive loss of carpal height. Although scaphoidectomy with partial wrist fusion is a well-established procedure for degenerative wrist patterns, the degree of PSCC and variables influencing this process remain poorly defined. A clearer understanding of PSCC patterns may guide surgical decision-making, patient counseling, and long-term expectations of stability after fusion.

A retrospective review was conducted of patients undergoing scaphoidectomy with partial wrist fusion by fellowship-trained wrist surgeons. Eligible patients were adults with appropriate radiographs preoperatively, at initial follow-up, and at a minimum of 6 months postoperatively. Carpal height and carpal height ratio were measured from standardized posteroanterior wrist radiographs. PSCC was defined using clinically meaningful thresholds based on changes in these measurements. Clinical variables, including demographics, comorbidities, fixation technique, hand dominance, smoking status, and complications, were collected. PSCC was evaluated as both a continuous and categorical variable. Factors associated with collapse were examined through univariate and multivariable analysis.

A total of 106 wrists were screened, with 72 meeting inclusion criteria. Clinically meaningful PSCC (≥2 mm) occurred in 43.1% of wrists. Current smoking and dominant-hand surgery were associated with greater collapse across assessment methods. Other clinical variables, including age, comorbidities, fixation construct, and indication for surgery, showed no association with collapse. On multivariable evaluation, dominant-hand surgery remained the primary factor associated with greater collapse. Additionally, postoperative complications were more frequently observed in patients with PSCC.

Radiographic PSCC following scaphoidectomy with partial wrist fusion is common and appears most influenced by dominant-side surgery. These findings suggest a need for careful postoperative monitoring, particularly in dominant-hand cases, though prospective data are needed to confirm these associations.

Postsurgical carpal collapse is a common radiographic finding following scaphoidectomy with partial wrist fusion. Recognition of factors associated with greater collapse may improve postoperative monitoring, surgical planning, and patient counseling.