Elsevier

The Journal of Hand Surgery

Volume 34, Issue 5, May–June 2009, Pages 832-837
The Journal of Hand Surgery

Scientific article
Range of Motion Effects of Distal Pole Scaphoid Excision and Triquetral Excision After Radioscapholunate Fusion: A Cadaver Study

https://doi.org/10.1016/j.jhsa.2009.02.007Get rights and content

Purpose

Radioscapholunate (RSL) fusion is an effective surgical procedure for the treatment of isolated radiocarpal arthritis. Although functional wrist motion is typically preserved through the midcarpal joint, many patients are still frustrated by postoperative limitations. The purpose of this study was to evaluate motion of cadaver wrists after simulated RSL fusion with excision of the distal pole of the scaphoid and the triquetrum.

Methods

Ten fresh-frozen cadaver upper extremities were mounted on a custom testing apparatus after isolation of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis longus, and extensor carpi ulnaris tendons. Sequential loading of these tendons resulted in flexion, extension, radial, and ulnar deviation. We subsequently measured range of motion with the use of digital photography. All specimens were tested in 4 states: intact (normal), RSL fusion (simulated), RSL fusion with distal scaphoid pole excision, and RSL fusion with distal scaphoid pole and triquetrum excision. The results were statistically analyzed using a repeated measures analysis of variance.

Results

Range of motion decreased to 39% to 46% of normal for flexion and extension and 65% to 71% of normal for radial and ulnar deviation after simulated RSL fusion. The addition of distal pole of scaphoid excision resulted in flexion and extension returning to 72% to 79% of normal, and radial and ulnar deviation returning to 84% to 89% of normal. Excision of the triquetrum further increased flexion and extension to 87% to 97% of normal, and radial and ulnar deviation to 119% to 137% of normal.

Conclusions

The combination of triquetral and distal scaphoid pole excision after RSL fusion improves wrist motion to levels close to normal in the cadaver model.

Section snippets

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

References (21)

There are more references available in the full text version of this article.

Cited by (34)

  • Radiocarpal Fusion: Indications, Technique, and Modifications

    2022, Journal of Hand Surgery
    Citation 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 Surgery
    Citation 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 Surgery
    Citation 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.

View all citing articles on Scopus

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

View full text