Capitolunate Arthrodesis versus Four-corner Arthrodesis in Scaphoin Nonunion Advanced Collapsed Wrist Treatment

Abstract

Objective To evaluate the outcomes of scaphoidectomy and capitolunate arthrodesis versus four-corner arthrodesis in patients with stage III scaphoid nonunion advanced collapse (SNAC) wrists.

Methods We reviewed retrospectively all of the consecutive patients surgically treated in our center between 2007 and 2015, including 20 patients in the four-corner arthrodesis group and 11 patients in the capitolunate group. The mean follow-up time was of 47 months. The follow-up evaluation included wrist range of motion (ROM), grip strength, visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and the Mayo wrist scale (MWS). Postoperative complications and the radiographic evaluation were also assessed.

Results There was no statistical difference in flexion, radial deviation, ulnar deviation, grip strength, VAS, DASH or MWS scores. There was a statistically significant increase (6°) in extension in capitolunate arthrodesis versus four-corner arthrodesis, possibly without clinical relevance. There were two nonunions in the four-corner group, and none in the capitolunate group. None of the patients in the capitolunate group required screw removal. One patient in the four-corner group required dorsal plate removal. One patient in each group required conversion to total arthrodesis.

Conclusions Capitolunate arthrodesis shows similar results in wrist ROM, grip strength and patient-reported outcomes when compared with four-corner arthrodesis at an average follow-up period of 4 years. We did not have any pisotriquetral arthritis in the capitolunate arthrodesis group, despite not removing the triquetrum in any of patients of this group.

Type of study/level of evidence Therapeutic III.

Resumen

Objetivo Evaluar los resultados de la escafoidectomía y de la artrodesis lunogrande frente a la artrodesis cuatro esquinas en pacientes con muñecas SNAC (Scaphoid Non-union Advanced Collapse) estadío III.

Métodos Evaluamos retrospectivamente todos los pacientes intervenidos quirúrgicamente en nuestro centro de forma sucesiva entre 2007 y 2015, incluyendo 20 pacientes en el grupo de la artrodesis cuatro esquinas y 11 pacientes en el grupo de la artrodesis lunogrande. El seguimiento medio fue de 47 meses. El seguimiento incluyó la evaluación del rango de movimiento de la muñeca, la fuerza de agarre, la escala analógica visual (VAS), el cuestionario de discapacidades del brazo, hombro y mano (DASH), y la escala de muñeca de Mayo (MWS). También se valoraron las complicaciones postoperatorias y las pruebas de imagen solicitadas.

Resultados No hubo diferencias estadísticamente significativas en la flexión, desviación radial, desviación ulnar, fuerza de agarre, ni en las escalas VAS, DASH o MWS. Se evidenció un incremento estadísticamente significativo (seis grados) en la extensión en el grupo de la artrodesis lunogrande frente a la artrodesis cuatro esquinas, posiblemente sin relevancia clínica asociada. Se registraron dos no uniones en el grupo de la artrodesis cuatro esquinas, y ningún caso en el grupo de la artrodesis lunogrande. Ninguno de los pacientes en el grupo de la artrodesis lunogrande requirió la retirada del tornillo. Un paciente en el grupo de la artrodesis cuatro esquinas precisó de la retirada de la placa dorsal. Un paciente de cada grupo requirió la conversión a artrodesis total de muñeca.

Conclusiones La artrodesis lunogrande muestra resultados similares en rango de movimiento de la muñeca, fuerza de agarre y satisfacción percibida por el paciente respecto a la artrodesis cuatro esquinas con un seguimiento medio de cuatro años. No hubo ningún caso de artrosis piramido-pisiforme a pesar de no haber eliminado el piramidal en ninguno de los pacientes.

Tipo de estudio/nivel de evidencia Terapéutico III.

Keywords

arthrodesis - four-corner arthrodesis - capitolunate - fusion - wrist

Palabras clave

artrodesis - artrodesis cuatro esquinas - lunogrande - fusión - muñeca

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