Abstract
Background Scapholunate advanced collapse and scaphoid nonunion advanced collapse result in
high morbidity and pose significant challenges for active patients. Multiple treatment
options have been proposed to yield satisfactory results; however, restoration of
physiological wrist motion remains an issue.
Questions/Purposes The objective of this study was to compare wrist mobility after four different treatment
methods for grade III wrist collapse: (1) no treatment, (2) scaphoidectomy and lunate-capitate
arthrodesis, (3) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum-hamate
arthrodesis, and (4) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum excision.
Methods Four paired (n = 8) fresh-frozen human cadaveric upper limbs were used in this controlled laboratory
study. Computed tomography scans were collected at all testing states and measurements
were made to evaluate midcarpal joint mobility and alignment.
Results A significant decrease in wrist extension was observed for all treatments. Middle
column and two-column arthrodesis demonstrated no significant differences for carpal
alignment and mobility. No significant differences were observed for triquetrum-hamate
mobility or wrist extension between the partial and two-column arthrodesis. Triquetrum
excision significantly improved ulnar deviation.
Conclusion The most important finding of this study was that the one-column arthrodesis has
comparable carpal alignment and range of motion to that of bi-column arthrodesis.
Clinical Relevance The results of this study suggest that a stage III advanced wrist collapse can be
treated by isolated lunate-capitate arthrodesis with scaphoidectomy. Fusion between
the remaining carpal bones may not be necessary because the carpal alignment and range
of motion of the remaining joints were not significantly different in the present
study.
Keywords
scaphoid nonunion advanced collapse - arthritis - advanced collapse - biomechanics
- wrist
