Scientific articleRange of Motion Effects of Distal Pole Scaphoid Excision and Triquetral Excision After Radioscapholunate Fusion: A Cadaver Study
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Materials and Methods
We used 10 fresh-frozen, upper-extremity cadaver specimens in this study, with an age range of 49 to 81 years (65 ± 13 SD years). None had evidence of wrist trauma, arthritis, or previous surgery. Each above-elbow specimen was mounted onto a custom-designed testing frame (Fig. 1) with 2 0.125-inch (3.2-mm) diameter K-wires drilled through the radius and ulna to maintain the forearm in a vertical position. To replicate physiologic motion in the cadaver wrists, 4 tendons proximal to the wrist
Results
The average range of motion for the intact (normal) wrist was 70° of flexion, 56° of extension, 30° of radial deviation, and 31° of ulnar deviation. Range of motion was found to decrease significantly to 39% of normal for flexion, 46% of normal for extension, 65% of normal for radial deviation, and 71% of normal for ulnar deviation after simulated RSL fusion (Fig. 3,Table 1).
Distal pole scaphoid excision after fusion resulted in improvement in all 4 motions, with the maximum effect on flexion,
Discussion
Isolated RSL osteoarthritis is primarily a posttraumatic condition resulting from intra-articular distal radius fractures. Nonsurgical treatment options include activity modification, temporary immobilization, nonsteroidal anti-inflammatory medications, and selective intra-articular injections of corticosteroids. In many patients with more advanced disease, however, the pain relief gained by these efforts is limited.1 For these patients, multiple surgical options have been described including
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Radiocarpal Fusion: Indications, Technique, and Modifications
2022, Journal of Hand SurgeryCitation Excerpt :Similarly, limitations in ROM after RSL arthrodesis may be the result of a scaphoid being unable to flex after fusion to the radius. The scaphoid typically flexes during wrist flexion and radial deviation, both of which are likely to be affected in the setting of RSL arthrodesis.11,30 To address the concerns of the high rates of nonunion, limitations in postoperative ROM, and high rates of progression of arthritis, some have advocated for DSE in addition to RSL arthrodesis.11
The Biomechanical Effects of Simulated Radioscapholunate Fusion With Distal Scaphoidectomy, 4-Corner Fusion With Complete Scaphoidectomy, and Proximal Row Carpectomy Compared to the Native Wrist
2021, Journal of Hand SurgeryCitation Excerpt :One 1.6-mm Kirschner wire was then inserted into the dorsal aspect of the distal radius and into the body of the lunate. In a similar fashion, the scaphoid was fixed to the scaphoid fossa of the radius using one 1.6-mm Kirschner wire.15 An osteotomy was then performed to excise the distal scaphoid at the level of the scaphoid waist distal to the implants.
Biomechanical Effects of Radioscapholunate Fusion With Distal Scaphoidectomy and Triquetrum Excision on Dart-Throwing and Wrist Circumduction Motions
2021, Journal of Hand SurgeryCitation Excerpt :Bain et al7 reported that no midcarpal dislocation or secondary degeneration occurred in their case series. Pervaiz et al13 observed no distal row instability in any of their test specimens, all of which were stressed under live fluoroscopy to check for instability, but they did not conduct a quantitative analysis. Our study showed that significant dorsal translation occurred after excision of the distal scaphoid and triquetrum compared with that of RSL fusion alone.
Radioscapholunate fusion for posttraumatic osteoarthritis with consecutive excision of the distal scaphoid and the triquetrum: A comparative study
2020, Hand Surgery and RehabilitationA Biomechanical Comparison of Modified Radioscapholunate Fusion Constructs for Radiocarpal Arthritis
2020, Journal of Hand Surgery
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