Changes in Wrist Motion After Simulated Scapholunate Arthrodesis: A Cadaveric Study.
Citation: Journal of Hand Surgery - American Volume. 41(9):e285-93, 2016 SepPMID: 27570228Institution: Curtis National Hand Center | MedStar Union Memorial Hospital | MedStar Washington Hospital CenterDepartment: Orthopaedic Surgery | Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Lunate Bone/su [Surgery] | *Scaphoid Bone/su [Surgery] | *Wrist Joint/su [Surgery] | Aged | Aged, 80 and over | Arthrodesis | Arthrometry, Articular | Bone Screws | Cadaver | Fluoroscopy | Humans | Lunate Bone/dg [Diagnostic Imaging] | Lunate Bone/pp [Physiopathology] | Range of Motion, Articular | Scaphoid Bone/dg [Diagnostic Imaging] | Scaphoid Bone/pp [Physiopathology] | Wrist Joint/dg [Diagnostic Imaging] | Wrist Joint/pp [Physiopathology]Year: 2016Local holdings: Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - presentISSN:- 0363-5023
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 27570228 | Available | 27570228 |
Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present
CLINICAL RELEVANCE: These results may support reconsidering SL arthrodesis as a viable treatment option for acute or chronic SL instability with regard to apparent minimal adverse effects on functional wrist ROM.
CONCLUSIONS: The effects of simulated SL arthrodesis on radiocarpal and midcarpal motion compare favorably with motion after SL soft tissue repair and other reconstructive techniques that have been previously reported. The statistically significant decreases in wrist flexion and dart-thrower's extension-flexion after simulated SL arthrodesis are of questionable clinical importance.
Copyright (c) 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
METHODS: We performed baseline wrist ROM for 10 cadaveric wrists using a standardized mounting-and-weights system. Extension, flexion, radial deviation, ulnar deviation, dart-thrower's extension, and dart-thrower's flexion were assessed. Two 3.0-mm headless compression screws were inserted across the SL joint to simulate SL arthrodesis. Goniometric measurements and fluoroscopic imaging were repeated to assess ROM differences after simulated SL arthrodesis. We assessed SL angle and gap during testing to ensure there was no significant motion between the scaphoid and lunate, thus confirming stable simulated fusion. Differences in ROM were compared between baseline and simulated SL arthrodesis using paired t tests.
PURPOSE: A high incidence of nonunion and relatively poor outcomes with prior fixation techniques has precluded scapholunate (SL) arthrodesis as a standard treatment for SL instability. Our purpose was to determine the impact on range of motion (ROM) of simulated SL arthrodesis via headless screw fixation.
RESULTS: Mean SL angle remained constant between pre- and post-arthrodesis imaging (47degree +/- 6degree vs 46degree +/- 4degree) and did not change during post-arthrodesis ROM testing, indicating a stable simulated fusion. Compared with baseline, SL arthrodesis had a statistically significant reduction in maximum flexion of 6degree and 9degree based on fluoroscopy and goniometry, respectively, in dart-thrower's extension of 5degree and 9degree based on fluoroscopy and goniometry, respectively, and in dart-thrower's flexion of 6degree for both fluoroscopy and goniometry. No other ROMs after simulated SL arthrodesis were significantly different compared with baseline.
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