Stage III Advanced Wrist Collapse Treatment Options: A Cadaveric Study

• Published in: Journal of wrist surgery Vol. 5; no. 4; pp. 265 - 272
• Main Authors: Chahla, Jorge, Schon, Jason M., Olleac, Ramiro, Senes, Sebastián, Arroquy, Damián, Dean, Chase S., Clembosky, Gabriel, Muratore, Alvaro
• Format: Journal Article
• Language: English
• Published: 333 Seventh Avenue, New York, NY 10001, USA Thieme Medical Publishers 01-11-2016
• Subjects: Scientific; Scientific Article; biomechanics; scaphoid nonunion advanced collapse; arthritis; advanced collapse; wrist
• ISSN: 2163-3916; 2163-3924
• DOI: 10.1055/s-0036-1579764

Abstract
Background
 Scapholunate advanced collapse and scaphoid nonunion advanced collapse result in high morbidity and pose significant challenges for active patients. Multiple treatment options have been proposed to yield satisfactory results; however, restoration of physiological wrist motion remains an issue.
Questions/Purposes
 The objective of this study was to compare wrist mobility after four different treatment methods for grade III wrist collapse: (1) no treatment, (2) scaphoidectomy and lunate-capitate arthrodesis, (3) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum-hamate arthrodesis, and (4) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum excision.
Methods
 Four paired (
n
 = 8) fresh-frozen human cadaveric upper limbs were used in this controlled laboratory study. Computed tomography scans were collected at all testing states and measurements were made to evaluate midcarpal joint mobility and alignment.
Results
 A significant decrease in wrist extension was observed for all treatments. Middle column and two-column arthrodesis demonstrated no significant differences for carpal alignment and mobility. No significant differences were observed for triquetrum-hamate mobility or wrist extension between the partial and two-column arthrodesis. Triquetrum excision significantly improved ulnar deviation.
Conclusion
 The most important finding of this study was that the one-column arthrodesis has comparable carpal alignment and range of motion to that of bi-column arthrodesis.
Clinical Relevance
 The results of this study suggest that a stage III advanced wrist collapse can be treated by isolated lunate-capitate arthrodesis with scaphoidectomy. Fusion between the remaining carpal bones may not be necessary because the carpal alignment and range of motion of the remaining joints were not significantly different in the present study.