Ostéotomie d’horizontalisation de la glène radiale dans les pseudarthroses du scaphoïde carpien

Abstract

Purpose of the study We propose a different management scheme for painful post-traumatic osteoarthritis of the wrist resulting from pseudarthrosis of the carpal scaphoid bone. We report a prospective series with a maximum follow-up of 16 years. Material and methods From 1973 to 1990, we performed 100 first-intention wedge osteotomies of the distal radius in patients with painful pseudarthrosis of the carpal scaphoid bone. Inclusion criteria were painful wrists with established pseudarthrosis. The operation consisted in the removal of a small lateral wedge (base ≤ 0.5 cm) without affecting the length of the radius nor the function of the distal radio-ulnar joint. Twenty patients were lost to follow-up and follow-up was less than two years for two. The present series corresponds to 77 patients (all male manual laborers) followed for at least two years. Mean follow-up was 4 years (range 216 years). To evaluate outcome, we developed a devoted scoring system, the Scaphoid Pseudarthosis Hand Score, (SPHS, max 60 points) with items for pain, range of motion, grasping strength, work capacity, wrist function and post-traumatic arthritis. Results At last follow-up, the SPHS was 45.66 points versus 19.98 before surgery. The pain score was 8.51 versus 3.19: 67 patients (86%) were pain free or experienced mild pain for heavy work. Bone fusion or fibrous union was observed in 49 patients (64%) who were free of post-traumatic osteoarthritis; some improvement of which was observed in 11 other patients (14%) with less sclerotic bone. All patients but two resumed their occupational activities. Discussion Wedge osteotomy relieves pain and improves hand function by reducing the pressure applied to the radial and scaphoid joint surfaces. It acts positively in the event of post-traumatic arthritis, altering the dynamics of the wrist and producing the beneficial effects of styloidectomy. Although it was not the target, sound union of the pseudarthrosis observed in 25 patients at last follow-up was attributed to the applied treatment.