Scaphocapitate Arthrodesis Research Articles

Scaphocapitate Arthrodesis for Wrist Deformities: A Systematic Review.

Scaphocapitate arthrodesis (SCA) is a described technique for chronic wrist pathology such as Kienbock disease and carpal instability. The technique aims to preserve motion, while maintaining carpal height, preserving the radioscaphoid articulation, and offloading the lunate. Limited case series evaluate the outcomes of this previously described technique. We aim to determine if the collective, updated literature on outcomes of SCA support its continued application by the wrist surgeon. Furthermore, we investigated if any technical variations offer an advantage in improving patient-reported outcomes after SCA. A literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles selected for critical review were examined for patient demographic data, functional outcomes, radiographic outcomes, and complications. A qualitative analysis was then performed to synthesize the available date. A total of 18 unique articles published between 1991 and 2022 were identified, representing a total of 285 individual cases of SCA. Nonunion rate ranged 0%-22%. Preoperative visual analog scale pain scores ranged from 3.2 to 10, whereas postoperative visual analog scale pain scores ranged from 0 to 4. Patient-reported outcomes are reported by validated instruments, including the Disabilities of the Arm, Shoulder, and Hand, QuickDASH, Patient-rated Wrist Evaluation, and Mayo Wrist Score. SCA is a viable treatment option for patients with Kienbock disease. SCA offers reliable improvements in patient pain, grip strength, and patient-reported outcomes.

Scaphocapitate arthrodesis with lunate preservation for Kienböck’s disease: prospective outcomes study

PurposeThe study evaluated the efficacy of SC arthrodesis with lunate preservation for treating patients diagnosed with stage IIIB or IIIC Kienböck’s disease, who also exhibit neutral ulnar variance. The study further aimed to explore potential variations in outcomes between patients diagnosed with stage IIIB and IIIC Kienböck’s disease.MethodsThirty-two patients diagnosed with stage IIIB (n = 19) and stage IIIC (n = 13) Kienböck’s disease underwent SC arthrodesis with distal radius bone grafting stabilised by Herbert compression screws. All participants underwent pre- and post-operative assessments including VAS score for pain, ROM, grip strength, MMWS, and the Quick DASH score. Additionally, RS angle, LHI ratio, and CHI ratio were assessed.ResultsFor all patients, the mean operative time was 73 min, follow-up was 45.6 months, time to union was 14 weeks, and time to full return to work was 24 weeks. The rate of union at the arthrodesis site was 91% (29 out of 32 patients) whilst the incidence of postoperative degenerative arthritis was 36% (8 out of 32 patients). Regarding changes in the means of outcomes from pre- to post-operatively, the VAS score decreased from 8.2 to 1.3 and grip strength improved from 36 to 79%. The RS angle was corrected from 59° to 50°. Significant improvements were noted in the mean MMWS from 45 to 75 and QuickDASH score from 78 to 21. However, no significant changes were observed in ROM, LHI, and CHI. There were no significant differences between patients with stage IIIB and stage IIIC in terms of these parameters, except for differences observed in the RS angle, LHI, and CHI preoperatively and in LHI and CHI postoperatively.ConclusionEvidence level: II.Our research demonstrates that SC arthrodesis is a valuable approach for reducing pain, improving grip strength, and enhancing overall function in individuals with advanced Kienböck’s disease. Importantly, our results indicate no notable differences in outcomes between patients diagnosed with stage IIIB or IIIC Kienböck’s disease.

Scaphocapitate arthrodesis in late stages of Kienbock’s disease

Background Kienbock’s disease is characterized by osteonecrosis of the carpal lunate. Kienbock’s disease treatment remains controversial. Objective To evaluate the short-term clinical and radiologic outcomes of scaphocapitate arthrodesis (SCA) in treating symptomatic late-stage Kienbock’s disease. Methods According to Lichtman’s classification, this prospective study included 21 patients with Kienbock’s disease stage III. All patients underwent SCA under general anesthesia. Patients were followed up at 1 and 2 weeks, 1, 3, 6, 9, 12, and 18 months postoperative. Results At the end of follow-up, 33.3% of patients achieved excellent outcomes, 47.6% achieved good outcomes, and 19.0% achieved poor outcomes. Patients with excellent and good outcomes are younger than patients with poor outcomes (38.9 ± 11.0, 42.2 ± 10.1, and 54.5 ± 3.3 years, respectively). Patients in the excellent and good groups had significantly lower disabilities of the arm, shoulder, and hand score (21.7 ± 14.8, 23.5 ± 16.8, and 47.3 ± 7.4, respectively, P=0.028), significantly higher extension/flexion arc (72.1 ± 17.2, 70.3 ± 22.0, and 38.5 ± 5.1, respectively, P=0.019) and a significantly shorter time to complete union (8.4 ± 1.4, 10.7 ± 1.3, and 14.8 ± 1.9, respectively, P=0.001). Conclusions SCA for late-stage Kienbock’s disease (stage III) was associated with significant improvements in carpal height length and grip strength postoperatively. Age, disease stage, disabilities of the arm, shoulder, and hand score, extension/flexion arc, and time to full union are critical factors in determining the prognosis of Kienböck’s disease.

Examining the Efficacy of Arthroscopic Scaphocapitate Arthrodesis for Advanced Kienbock's Disease: Clinical and Radiological Outcomes.

Altering wrist biomechanics, Kienbock's disease leads to progressive carpal collapse that results in early arthritis and degenerative changes. By shifting the loading axis toward the radioscaphoid joint, scaphocapitate arthrodesis (SCA) has been reported as a salvage procedure effective in treating symptomatic patients with advanced Kienbock's disease. In this study, we aimed to evaluate the clinical and radiological outcomes of arthroscopic SCA in symptomatic patients with advanced stages of Kienbock's disease. Between March 2010 and February 2021, we included 15 patients with symptomatic stage IIIA (n=2) and stage IIIB (n=13) Kienbock's disease who were followed up for a minimum of 24 months after arthroscopic SCA with or without lunate excision. The lunate was excised in 6 patients and retained in 9. Visual analog scale (VAS) pain score, grip strength, range of motion (ROM), active flexion-extension arc, and modified Mayo wrist score (MMWS) were measured preoperatively and at each follow-up examination after surgery. Operation-related complications and radiographic changes were also assessed. There were 13 women and 2 men, with a mean age of 57.6 years (range, 21-74 years) at the time of undergoing arthroscopic SCA. Follow-up ranged from 24 to 116 months, with an average of 56.9 ± 32.3 months. Bony union was achieved in all patients. At preoperative examination, wrist ROM (67%) and grip strength (48%) significantly decreased, compared to the contralateral wrist. At the final follow-up, there were significant improvements in VAS, grip strength, and MMWS, whereas the active wrist ROM showed no significant change. Radioscaphoid angle recovered after surgery, while radiographic carpal collapse and ulnar translation of the carpus occurred. In subgroup analysis according to excision of the lunate, there were no significant differences in VAS, MMWS, grip strength, or total ROM. However, increased ulnar translation and decreased radial deviation were noted in the lunate excision group. Arthroscopic SCA achieved significant improvements in pain and wrist function in patients with advanced Kienbock's disease without any complications. Excision of the lunate when performing arthroscopic SCA seemed to induce progressive carpal ulnar translation, with no apparent clinical benefits over retaining it.

The effect of intercarpal arthrodeses on wrist kinematics during radial and ulnar deviation: a cadaveric study using four-dimensional CT.

In this cadaveric study, we report quantitative dynamic four-dimensional CT evaluation of the effect on wrist kinematics of three intercarpal arthrodeses during radial and ulnar deviation. In five wrists, we successively performed scaphocapitate, four-corner and two-corner fusions. Four-dimensional CT examinations were performed prior to dissection and after each arthrodesis. The lunocapitate gap, posterior lunocapitate angle, radiolunate radial gap, radiolunate ulnar gap and radiolunate angle were assessed. After scaphocapitate arthrodesis, in radial deviation, we noted midcarpal diastasis and dorsal displacement of the capitate. In ulnar deviation, there was correction of that incongruence. After four-corner and two-corner fusions, in radial deviation, we noted radial radiolunate impingement and ulnar radiolunate incongruence. In ulnar deviation, after two-corner fusion, ulnar radiolunate impingement and radial radiolunate incongruence were present contrary to four-corner fusion. Our findings confirm that the constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after these arthrodeses.

Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis

To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.

Combined radial wedge and shortening osteotomy versus scaphocapitate arthrodesis in advanced Kienböck’s disease

Although various surgical techniques have been reported for the treatment of advanced Kienböck's disease (Lichtman stage IIIB and above), the ap- propriate operative treatment is still being debated. This study compared the clinical and radiological outcomes of combined radial wedge and shortening osteotomy (CRWSO) and scaphocapitate arthrodesis (SCA) in the treatment of advanced Kienböck's disease (above type IIIB) with a minimum of 3 years of follow-up. We analyzed the data from 16 and 13 patients who underwent CRWSO and SCA, respectively. The average follow-up period was 48.6±12.8 months. Clinical outcomes were evaluated using the flexion-extension arc, grip strength, Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Visual Analogue Scale (VAS) for pain. The following radiological parameters were measured: ulnar variance (UV), carpal height ratio (CHR), radioscaphoid angle (RSA), and Stahl index (SI). Osteoarthritic changes in the radiocarpal and midcarpal joints were evaluated using computed tomography (CT). Clinically, both groups showed significant improvements in the grip strength, DASH, and VAS at final follow-up. However, regarding the flexion-extension arc, the CRWSO group showed a significant improvement, while the SCA group did not. Radiologically, compared to the preoperative values, the CHR results improved at final follow-up in the CRWSO and SCA groups. There was no statistically significant difference in the degree of CHR correction between the 2 groups. By the final follow-up visit, none of the patients in either group had progressed from Lichtman stage IIIB to stage IV. Considering restoration of wrist joint range of motion, CRWSO may be a good alternative for limited carpal arthrodesis for advanced Kienböck's disease.

Management of type 3 Kienbock's disease in manual workers by scaphocapitate fusion with minimum 7-year follow-up

BackgroundKienbock's disease results in altered wrist biomechanics producing debilitating pain at the wrist. The disease is staged according to radiological and clinical findings and the stage guides the treatment. Various treatment options have been described for stage 3, however, there is a lack of consensus over these treatment methods. Scaphocapitate fusion is the preferred surgical option for advanced Kienbock's disease. Previous studies had heterogeneous cohorts with a short duration of follow-up and a lack of uniform surgical technique. The purpose of the study was to show the long-term functional and radiological outcome of scaphocapitate arthrodesis (SCA) by using Herbert screw for the treatment of Kienbock's disease in manual workers. MethodsFor this single-centre, retrospective study, all consecutive patients who were manual workers and managed by SCA between January 2010 and Jan 2014 for Lichtman stage IIIA and IIIB with at least 7 years of follow-up were included. Patients were assessed using clinical and radiological parameters preoperatively and in the follow-up period. Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Related Wrist Evaluation (PRWE), and VAS for pain were assessed. ResultsOut of 27 patients, 4 lost to follow-up, therefore, 23 patients (14 women and 9 men) with 30 years of median age at the time of the surgery were included. DASH scores, PRWE scores, and VAS for pain significantly improved (p < 0.5) after surgery. Wrist range of motion and grip strength also improved significantly (p < 0.5). Postoperative radiological parameters were found to be within a normal range. ConclusionScaphocapitate fusion by Herbert screws gives good functional, clinical, and radiological outcomes, in stage 3 of Kienbock's disease with excellent rates of fusion with low complications. Even, in manual workers, scaphocapitate fusion can reliably provide good outcomes and this is maintained in the mid to long-term follow-up. Therefore, it should be considered as one of the procedures of choice. Level of evidenceRetrospective, Level 4.

Influence of carpal–ulnar translation on clinical outcome after scaphocapitate arthrodesis for the treatment of late-stage Kienböck disease

This study sought to compare postoperative outcomes after scaphocapitate arthrodesis (SCA) for the treatment of late-stage Kienböck disease according to the amount of ulnar translation of the carpus and to identify surgical factors associated with carpal-ulnar translation. Thirty-nine patients diagnosed with Kienböck disease (Lichtman stages III-IV) and treated with SCA were retrospectively reviewed. They were divided into the translated group (n=28) and untranslated group (n=11) according to the presence of carpal-ulnar translation. The following surgical factors in the patients were assessed: excision of the lunate, postoperative carpal height ratio, and radioscaphoid angle (RSA). Pain Visual Analog scale (VAS) score, wrist range of motion, grip strength, modified Mayo wrist score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and progression of radioscaphoid osteoarthritis were also assessed. All patients showed functional improvement after a mean postoperative follow-up period of 40 months (VAS: 4.1 vs. 1.1, p <0.001; grip strength, 42.3 vs. 51.2 lb., p=0.002; MMWS, 52.6 vs. 69.5, p <0.001; QuickDASH, 33.7 vs. 21.5, p <0.001). No statistically significant differences were found between the two groups in terms of outcome measures. Among the assessed surgical factors, the mean postoperative RSA was significantly smaller in the translated group than in the untranslated group (34.8° vs. 46.8°, p=0.008). The proportion of patients with postoperative RSA <30° was significantly higher in the translated group than in the untranslated group (54.5% vs. 0%, p<0.001). These results suggest that sufficient pain relief and functional improvement can be achieved after SCA for the treatment of late-stage Kienböck disease disregarding the occurrence of carpal-ulnar translation. In this study, overcorrection to RSA <30° induced more frequent carpal-ulnar translation after SCA.

A case report of lunate excision with scapho-capitate arthrodesis in Kienbock’s disease

Case study of a 22-year female presented to our clinic with complaints of dorsal wrist pain, swelling and stiffness with decreased motion at left wrist joint with a duration of 2 months without any significant traumatic history. On evaluation dorsal wrist pain and point tenderness over lunate bone was present. Radiographs and Advanced imaging MRI was suggestive of Kienbock’s disease. This was treated with Lunate excision and scapho-capitate arthrodesis along with bone grafting. Advanced stages of Kienbock’s are usually managed by Wrist fusion or proximal row carpectomy. We are reporting our result of scapho-capitate arthrodesis which was performed to stop progression of carpal collapse and carpal-ulnar translation and thereby preserve functional motion and provide pain relief.

Five Wrist Operations That Give the Best Results.

After reading this article and viewing the videos, the participant should be able to: 1. Recognize the following five wrist operations as consistent options for different wrist injuries: carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis. 2. Know the state-of-the-art of these five procedures. 3. State the indications of each operation. 4. List the surgical steps of these five procedures. The wrist is a complex joint that concentrates different types of tissues (e.g., bone, cartilage, ligaments, nerves, vessels) and a broad different spectrum of diseases. Treatment of wrist injuries has improved during recent years, mainly because of improvement in strategy, techniques, microsurgical equipment, understanding anatomy and improvements in technology. In this article, we present the five operations (i.e., carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis) that have consistently given good outcomes in patients suffering from different wrist injuries/maladies.

Update on the Use of Arthroscopy in Kienböck's Disease Management

AbstractKienböck's disease is a clinical-radiological condition that can permanently affect wrist functionality and the patient's quality of life. Proper, pertinent diagnosis and treatment are required to avoid salvage procedures. Arthroscopic techniques have emerged as an important tool for the treatment of certain stages of the disease.We present a review of the literature and propose a treatment algorithm according to the stage of the disease, including arthroscopic techniques. We detail the surgical technique of arthroscopic scaphocapitate arthrodesis, and the functional outcomes obtained by our group.

Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis.

Background Kienböck's disease leading to progressive carpal collapse alters the wrist biomechanics leading to early arthritis and degenerative changes. Out of multiple surgical procedures present, no gold standard has been described. Scaphocapitate arthrodesis (SCA) is limited carpal fusion which shifts the loading axis toward radioscaphoid joint. This study presents the midterm clinical and radiological results of SCA in Kienböck's disease. Materials and Methods The data were reviewed from January 2016 to December 2017. Lichtman's classification used to stage the disease. Clinical variables were noted for wrist range of motion, grip strength, visual analog scale (VAS) score, quick disabilities of the arm, shoulder, and hand (quickDASH), and patient-rated wrist evaluation (PRWE) scores. Radiographs were evaluated for union, ulnar variance, carpal height ratio, radioscaphoid angle, and scapholunate angle. Results A total of 11 patients of Stage IIIA and IIIB Kienböck's disease with mean age of 24 years were included in the study with a minimum of 18 months of clinical follow-up. The procedure resulted in decreased ranges of motion but improved grip strength (26.09 ± 4.76 from 19.54 ± 4.63 kgf) and reduced pain with VAS score decreased from 7.36 ± 0.8 to 2 ± 1. Radiographic analysis showed union in all patients, reduced carpal height with a corrected radioscaphoid angle (from 62.12 to 48.3 degrees), and scapholunate angle (from 34 to 26.27 degrees). Discussion SCA has advantage of technical ease of orientation of the scaphoid and osteosynthesis of only one intercarpal joint with a large contact surface. Coupling the distal and proximal carpal rows results in significant loss of mean wrist range of motion but with improved grip strength, shifting the load away from the radiolunate joint. However, long-term studies are needed for clinical benefits and radiographic signs of radioscaphoid arthritis for the treatment of advanced-stage Kienböck's disease. Level of Evidence This is a Level IV, retrospective observational study.

Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up.

IV.

Lunatum excision and scaphocapitate arthrodesis in Kienböck's disease.

The aim of this study was to compare functional results before and after lunatum excision and scaphocapitate arthrodesis (SCA) using an angular stable circular plate in patients with Lichtman's stage IIIB Kienböck's disease. The study included nine patients (six females and three males) with a mean age of 33.2 ± 11 years (range: 18-54 years). Clinical and radiological assessment before and after surgery included wrist extension and flexion, range of motion and grip strength, visual analogue scale (VAS) score to assess pain, modified Mayo wrist scores, and measurements of the scapholunate (SL) angle and modified carpal height ratio. The mean follow-up period was 17.33 ± 4.69 months (range: 12-24 months), mean operation time was 56.67 ± 12.5 min (range: 45-75 min) and mean hospitalization time was 3.44 ± 1.13 days (range: 2-6 days). Preoperative mean wrist extension was 23.89° ± 4.17°, mean wrist flexion was 32.22° ± 5.07°, mean grip strength compared to the healthy side was 34% (range: 28-37%) and mean VAS score was 7.6 (range: 7-8). Modified Mayo wrist scores were poor in all of the nine patients. Post-operative mean wrist extension was 27.78° ± 4.41°, mean wrist flexion was 40.56° ± 4.64°, mean grip strength compared to the healthy side was 71% (range: 63-81%) and mean VAS score was recorded as 1.4 (range: 1-2). Modified Mayo wrist scores were good in five and moderate in four patients. No patients had non-union or additional surgery. Lunatum excision and SCA using angular stable circular plate fixation provide pain relief with acceptable preservation of the range of motion.

Endoscopic bone graft harvesting of the distal radius

Arthroscopic managements of scaphoid nonunions or partial wrist arthrodesis have been described with good results. Unfortunately, the bone graft harvesting is still performed from the iliac crest or the distal radius using an open approach. It means that the bone graft harvesting necessitates a wider approach than the intra-articular wrist surgery if performed with arthroscopy. We developed an endoscopic procedure to perform bone graft harvesting from the distal radius and we evaluated its efficiency and morbidity in a clinical prospective series. We developed and secured the procedure on 2 wrist cadaveric specimens. Technique – we used a 1,9 mm arthroscope with 35 mmHg pump pressure, a 2 mm shaver blade + 2 dorsal portals on the same line separated from 2.5 cm, located 5 mm proximal to the Lister's tubercle. Under arthroscopy, we performed an identification and excision of the periosteal, then we introduced a 2.3 mm bone biopsy kit, 7 holes of bone harvesting were performed in the metaphyseal part of the distal radius, proximal to the Lister's. Prospective clinical series – 16 patients were included: 11 scaphoid nonunions, 2 scaphocapitate arthrodesis (Kienböck's disease), 3 phalanx nonunions. The arthroscopic bone harvesting was performed first then the grafting was performed second. Evaluation – clinical examinations were performed after 1, 3 and 6 months; we evaluated the tenderness on the harvesting site, tendons or sensitive nerves damages, scare appearance using a VAS scare satisfaction score, X ray bone healing of the harvesting and grafting site. The average duration of the endoscopic bone graft harvesting was 13 minutes. Clinical outcomes (n = 16); efficiency: no tenderness was observed after 6 months + VAS scare satisfaction score after 6 months was 9 (8–10) + 30% of bone holes was still visible on X ray after 6 months. All bone fixations achieved consolidation except one former and very proximal scaphoid nonunion. Safety: no tendinous or sensitive skin disorders was observed. Improvements of mini-invasive surgery for small bone nonunions have been recently achieved but the originality of our work was focus on the improvement of bone graft harvesting using an endoscopic technique. This study confirmed the feasibility and safety of an endoscopic bone graft harvesting of the distal radius. This procedure is efficient to obtain enough cancellous bone for nonunions of the hand. It is a safe technique that can be used for intra-articular arthroscopic grafting but also phalanx or metacarpal nonunions.

Prélèvement osseux du radius distal par voie endoscopique

Arthroscopic managements of scaphoid nonunions or partial wrist arthrodesis have been described with good results. Unfortunately, the bone graft harvesting is still performed from the iliac crest or the distal radius using an open approach. It means that the bone graft harvesting necessitates a wider approach than the intra-articular wrist surgery if performed with arthroscopy. We developed an endoscopic procedure to perform bone graft harvesting from the distal radius and we evaluated its efficiency and morbidity in a clinical prospective series. Material & method We developed and secured the procedure on 2 wrist cadaveric specimens. Technique We used a 1,9 mm arthroscope with 35 mmHg pump pressure, a 2 mm shaver blade; 2 dorsal portals on the same line separated from 2,5 cm, located 5 mm proximal to the Lister's tubercle. Under arthroscopy, we performed an identification and excision of the periosteal, then we introduced a 2,3 mm bone biopsy kit, 7 holes of bone harvesting were performed in the metaphyseal part of the distal radius, proximal to the Lister's. Prospective clinical series Sixteen patients were included: 11 scaphoid nonunions, 2 scaphocapitate arthrodesis (kienbock disease) and 3 phalanx nonunions. The arthroscopic bone harvesting was performed first then the grafting was performed second. Evaluation Clinical examinations were performed after 1, 3 and 6 months, we evaluated the tenderness on the harvesting site, tendons or sensitive nerves damages, scare appearance using a VAS scare satisfaction score, X-ray bone healing of the harvesting and grafting site. Results The average duration of the endoscopic bone graft harvesting was 13 minutes (8–22). Clinical outcomes ( n = 16): – efficiency: none tenderness was observed after 6 months; VAS scare satisfaction score after 6 months was 9 (8–10); 40% of bone holes was still visible on X-ray after 6 months. All bone fixations achieved consolidation except one former and very proximal scaphoid nonunion; – safety: none tendinous or sensitive skin disorders were observed. Discussion Improvements of mini-invasive surgery for small bone non-unions have been recently achieved but the originality of our work was focus on the improvement of bone graft harvesting using an endoscopic technique. Summary points This study confirmed the feasibility and safety of an endoscopic bone graft harvesting of the distal radius. This procedure is efficient to obtain enough cancellous bone for nonunions of the hand. It is a safe technique that can be used for intra-articular arthroscopic grafting but also for phalanx or metacarpal nonunions.

Load distribution on the radio-carpal joint for carpal arthrodesis

Background and objectiveCarpal fusions are useful for treating specific carpal disorders, maximizing postoperative wrist motion, hand strength, reducing pain and instability of the joint. The surgeon selects the appropriate treatment by considering the degree of stability, the chronicity of the injury, functional demands of the patient and former patient's outcomes as well. However there are not many studies regarding the load distribution provided by the treatment. So, the purpose of this study is to analyze the load distribution through the wrist joint with an arthrodesis treatment and compare the results with a normal wrist. MethodTo this end the rigid body spring model (RBSM) method was used on a three-dimensional model of the wrist joint. The cartilage and ligaments were simulated as springs acting under compression and tension, respectively, while the bones were considered as rigid bodies. To simulate the arthrodesis, the fused bones were considered as a single rigid body. ResultsThe changes on the load distribution for each arthrodesis agree with the treatment objective, reducing load transmission through a specific articular surface. For example, for SLAC/SNAC II most of the treatments reduced the load transmitted through the radioscaphoid fossae, almost by 8%. However, the capitolunate (CL) arthrodesis was the treatment that managed to keep the load transmitted through the radiolunate joint closer to normal conditions. Also, in treatments where the scaphoid was excised (3-corner, 4-corner and capitolunate arthrodesis), the joint surface between the lunate surface compensates by doubling the transmitted force to the radius. ConclusionsThe common arthrodesis for treating SLAC/SNAC II-III, reduces, in fact, the load on the radioscaphoid joint. Alternative treatments that reduce load distribution on the radiocarpal joint should be three corner and capitolunate arthrodesis for treating SLAC/SNAC-II; and for SLAC/SNAC-III four corners with scaphoid excision. On Kienbock's disease. Scaphocapitate (SC) arthrodesis is more effective on reducing the load transmission through the radiolunate and ulnolunate joints. All arthrodesis treatment should consider changes on the load transmission, and also bones’ fusion rates and pain reduction on patient's outcomes.

Scaphocapitate Arthrodesis for Kienböck Disease

To assess the effect of scaphocapitate arthrodesis (SCA) on grip strength and wrist motion for patients with advanced stages of Kienböck disease. A retrospective review was conducted of patients with advanced stages of Kienböck disease (stages III-IV) who underwent SCA at our institution between 1991 and 2010 with a minimum of 1 year clinical follow-up. Outcome measures included preoperative and postoperative pain, range of motion, grip strength, complications, additional surgery, radiographic changes, and the modified Mayo Wrist and Lichtman Outcome scores. Twenty-seven patients (17 males and 10 females) with a mean age of 41 years (range, 15-66 y) at the time of SCA were included in the study. The mean follow-up period was 60 months (range, 12 mo-16 y). Union was achieved in all 27 patients. Significant loss of mean motion was noted from preoperative to postoperative in wrist flexion (14°), extension (11°), and ulnar deviation (9°). However, significant improvement in grip strength was noted (+7 kg). Modified Mayo Wrist scores were mostly fair to poor and Lichtman scores were satisfactory in 32% (n= 7) of patients, yet 74% of patients returned to regular employment. Progressive radiographic carpal collapse and ulnar translocation of the carpus occurred, particularly in patients who had lunate excisions. However, no patients had symptoms attributable to carpal collapse or ulnar translocation that necessitated additional surgery. SCA resulted in improved grip strength with correction of carpal alignment in patients with advanced stages of Kienböck disease in medium-term follow-up. Although radiographic carpal collapse and ulnar translocation occurred, patients were not symptomatic. Patients should be counseled that decrease in wrist range of motion will likely occur. Therapeutic IV.

Limited intercarpal fusion as a salvage procedure for advanced Kienbock disease.

With progressive lunate collapse, salvage procedures in advanced Kienbock disease attempt to provide pain relief and maintain motion. Scaphocapitate arthrodesis may provide a durable option with comparable outcomes to proximal row carpectomy in the well-selected patient. We performed a retrospective chart review of all consecutive patients with Lichtman stage IIIA or IIIB Kienbock's disease who underwent either scaphocapitate or scaphotrapeziotrapezoid-capitate arthrodesis from January 2004 to December 2013. Twelve patients were included with a mean age of 41.6years. Ten patients underwent scaphocapitate arthrodesis, while two patients underwent scaphotrapezio-trapezoid-capitate arthrodesis with an average clinical follow-up of 13.1months. All patients achieved fusion. The average postoperative flexion-extension arc was 53° (range 20-110°). The average ulnar deviation was 9° (range 5-15°), and the average radial deviation was 13° (range 5-25°). Postoperative pain scores were significantly improved, having changed from an average of 6.6 preoperatively to 2.8 on a 10-point scale (W = 18, P < 0.05). Despite a mean flexion-extension arc that is reduced from that of a normal individual, the postoperative range of motion following a midcarpal arthrodesis was not significantly different than that reported in a recent systematic review of proximal row carpectomy (73.5° compared with 53°, respectively) (P = 0.05). Additionally, given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease.