Treatment of Proximal Scaphoid Non-union by Resection of the Proximal Pole and Palmaris Longus Interposition Arthroplasty

Abstract

Background: The purpose of this study was to determine the long-term clinical and radiographic outcome in a group of patients treated with resection of the proximal pole and tendon ball arthroplasty because of a scaphoid non-union.

Patients and Methods: 15 patients affected by scaphoid non-union and treated with resection arthroplasty were studied at a mean follow-up of 9.1 years. The assessment included a visual analogue scale (VAS) to evaluate pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the measurement of grip and pinch strength. We also evaluated pre-operative and follow-up radiographs to determine the stage of SNAC wrist.

Results: We obtained a good subjective clinical result in 11 patients and a poor result in 4. Mean VAS and DASH score at follow-up was 1.2±1.2 and 12±12,1, respectively. Grip and key pinch strength in the surgically treated hand were 89% of the contralateral hand. There was significant increase in the SNAC stage at follow-up with respect to the preoperative evaluation in the operated wrist.

Conclusion: Resection of the proximal pole and tendon ball arthroplasty provided long-term relief of pain and good functional results in most patients affected by scaphoid non-union. This technique did not affect the natural history of SNAC wrist with its clinical and functional consequences.

Zusammenfassung

Hintergrund: Ziel der Studie war es, das langfristige klinische und radiografische Ergebnis der Behandlung einer proximalen Kahnbeinpseudarthrose mittels Ersatz des proximalen Pols durch Interposition eines Sehnenballes zu ermitteln.

Patienten und Methoden: 15 Patienten, bei denen bei einer Kahnbeinpseudarthrose der proximale Pol reseziert und durch einen Sehnenball ersetzt worden war, konnten im Mittel nach 9,1 Jahren erneut untersucht werden. Neben der Messung der Grob- und Feingriffstärke wurden die Schmerzen mit der visuellen Analogskala (VAS) und die Einschränkung der Gebrauchsfähigkeit der oberen Extremität mit dem DASH-Fragebogen ermittelt. Weiterhin erfolgte eine Auswertung der präoperativen und der bei der Nachuntersuchung gefertigten Röntgenaufnahmen.

Ergebnisse: 11 Patienten erzielten subjektiv ein gutes klinisches Resultat, 4 ein schlechtes. Die mittleren VAS- und DASH-Werte bei der Nachuntersuchung lagen bei 1.2±1.2 bzw. 12±12,1. Grob- und Feingriffstärke betrugen 89% der kontralateralen Hand. Radiologisch fand sich eine signifikante Verschlechterung bei der Nachuntersuchung im Vergleich zur präoperativen Untersuchung.

Schlussfolgerung: Der Ersatz des proximalen Kahnbeinpoles mit einem Sehnenball bei proximaler Kahnbeinpseudarthrose führt bei den meisten Patienten zu langfristiger Schmerzlinderung und guten funktionalen Resultaten. Die Entwicklung eines karpalen Kollaps mit den sich daraus ergebenden Konsequenzen lässt sich jedoch nicht verhindern.

Key words

scaphoid non-union - avascular necrosis - SNAC-wrist - tendon interposition arthroplasty

Schlüsselwörter

Kahnbeinpseudarthrose - aväskulare Nekrose - SLAC-wrist - Sehneninterpositionsarthroplastik

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