Radioskapholunäre Arthrodese mit Entfernung des distalen Skaphoidpols von palmar

Abstract

Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited to the radiocarpal joint. Osteoarthritis limited to the radiocarpal joint with intact mediocarpal joint after malunited intra-articular distal radius fractures, rheumatoid osteoarthritis, scapholunate advanced collapse (SLAC) up to stageII. Mediocarpal osteoarthritis, poor patient compliance, SLAC from stageIII, osteitis. The palmar RSL arthrodesis is performed using the palmar approach between the flexor carpi radialis tendon and the radial artery. After releasing the pronator quadratus muscle, alongitudinal capsulotomy is performed and the radiocarpal joint is inspected. After correction of avolar or dorsal intercalated segmental instability of the lunate, the lunate is temporarily fixed to the scaphoid using aK-wire. The distal quarter of the scaphoid and the palmar rim of the distal radius is resected and the cartilage between the scaphoid, lunate and distal radius is removed. The scaphoid and lunate are temporarily fixed to the distal radius using K‑wires. Under image intensifier control the angular stable low-profile plate (e.g., volar 2.5 Trilock RSL Fusion plate [Medartis® Aptus® Basel, Switzerland]) is fixed to the distal radius in the long-leg hole. The scaphoid and lunate are fixed distally with two screws each. The carpus is pushed distally using aCodeman distractor and the cancellous bone graft is impacted. Finally, the shaft is fixed with angular stable screws. Immobilization using aplaster cast or thermoplastic short-arm orthosis for 5weeks. After 2weeks, the orthosis can be removed during hand therapy with active wrist and finger exercises. Normal activities permitted after 12 weeks. Palmar RSL arthrodesis and distal scaphoidectomy using angular stable plate fixation shows ahigh union rate and pain relief while maintaining good residual mobility of the wrist.