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European Journal of Orthopaedic Surgery & Traumatology

Open Access 23-04-2024 | Osteoarthrosis | Original Article

Outcomes after radioscapholunate arthrodesis for intra-articular malunion of distal radius fractures

Authors: Yasser Safoury, Ahmed Afifi, Ahmed Farghaly, Omar Khalid

Published in: European Journal of Orthopaedic Surgery & Traumatology

Abstract

Purpose

To study the clinical, radiological, and functional outcomes after of radioscapholunate (RSL) fusion for intra-articular malunion of the distal radius.

Methods

This retrospective study included 26 patients (17 males and 9 females) with intra-articular malunion of distal radius fractures who underwent RSL arthrodesis using locked miniplates (without distal scaphoid excision) between 2012 and 2020. Their mean age was 43 years (range, 32–56). Patients were assessed radiographically for union and clinically for range of motion, grip strength, and pain (assessed by Visual Analogue Scale (VAS) for pain). Functional evaluation was performed by using the Mayo modified wrist score (MMWS) and the Disabilities for the Arm, Shoulder, and Hand (DASH) questionnaire.

Results

All patients showed complete healing at the fusion site after a mean of 8.7 weeks (range, 8–12). The mean follow-up period was 72 months (range, 60–84). The pinch strength improved from a mean of 6.2 kg (range, 3–12) to a mean of 9.8 kg (range, 5–18) which represents 80% of the contralateral side. The mean pinch strength was 7 kg (range, 5–18) which presents 80% of the other side. VAS for pain showed a mean improvement of 72.6%. The DASH score improved to a mean of 19.2 (range, 14–24). The MMWS improved to a mean of 68 (range, 45–86). At the final follow-up period, no degenerative changes were detected in the midcarpal joint.

Conclusion

RSL arthrodesis (using locked miniplates without distal scaphoid excision) is a reliable surgical procedure to manage cases of radiocarpal OA after intra-articular malunion of distal radius fractures with good clinical and radiological outcomes.

Level of evidence

Level IV- therapeutic.

Garcia-Elias M, Lluch A, Ferreres A, Papini-Zorli I, Rahimtoola ZO (2005) Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy. J Hand Surg Am 30:8–15. https://doi.org/10.1016/j.jhsa.2004.09.001CrossRefPubMed

Bach AW (2003) Radiocarpal fusion. Tech Hand Up Extrem Surg 7:63–69CrossRefPubMed

Bach AW, Almquist EE, Newman DM (1991) Proximal row fusion as a solution for radiocarpal arthritis. J Hand Surg 16A:424–431CrossRef

Gordon LH, King D (1961) Partial wrist arthrodesis for old ununited fractures of the carpal navicular. Am J Surg V102:460–464CrossRef

Nagy L, Büchler U (1997) Long-term results of radioscapholunate fusion following fractures of the distal radius. J Hand Surg 22B:705–710CrossRef

Sturzenegger M, Büchler U (1991) Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius. Ann Chir Main Memb Super 10:207–216PubMed

Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126CrossRefPubMed

Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 4:407–414CrossRefPubMed

Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop 214:136–147CrossRef

10.

Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefPubMed

11.

Mühldorfer-Fodor M, Ha HP, Hohendorff B, Löw S, Prommersberger KJ, van Schoonhoven J (2012) Results after radioscapholunate arthrodesis with or without resection of the distal scaphoid pole. J Hand Surg Am 37:2233–2239. https://doi.org/10.1016/j.jhsa.2012.08.009CrossRefPubMed

12.

Quadlbauer S, Leixnering M, Jurkowitsch J, Hausner T, Pezzei C (2017) Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am 42(9):754.e1-754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031CrossRefPubMed

13.

Degeorge B, Montoya-Faivre D, Dap F, Dautel G, Coulet B, Chammas M (2019) Radioscapholunate fusion for radiocarpal osteoarthritis: prognostic factors of clinical and radiographic outcomes. J Wrist Surg 08:456–462. https://doi.org/10.1055/s-0039-1688939CrossRef

14.

Ha NB, Phadnis J, MacLean SBM, Bain GI (2018) Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up. J Hand Surg Eur 43:168–173CrossRef

15.

Bain GI, Ondimu P, Hallam P, Ashwood N (2009) Radioscapholunate arthrodesis - a prospective study. Hand Surg 14:73–82CrossRefPubMed

16.

Montoya-Faivre D, Pomares G, Calafat V, Dap F, Dautel G (2017) Clinical and radiological outcomes following radioscapholunate fusion. Orthop Traumatol Surg Res 103:1093–1098. https://doi.org/10.1016/j.otsr.2017.07.012CrossRefPubMed

17.

Moritomo H, Apergis EP, Herzberg G, Werner FW, Wolfe SW, Garcia-Elias M (2007) IFSSH committee report of wrist biomechanics committee: biomechanics of the so-called dart-throwing motion of the wrist. J Hand Surg Am 32:1447–1453CrossRefPubMed

18.

Brumfield RH, Champoux JA (1984) A biomechanical study of normal functional wrist motion. Clin Orthop Relat Res 187:23–25. https://doi.org/10.1097/00003086-198407000-00004CrossRef

19.

Palmer AK, Werner FW, Murphy D, Glisson R (1985) Functional wrist motion: a biomechanical study. J Hand Surg Am 10:39–46CrossRefPubMed

20.

McCombe D, Ireland DC, McNab I (2001) Distal scaphoid excision after radioscaphoid arthrodesis. J Hand Surg 26A:877–882CrossRef

21.

Garcia-Elias M, Llunch A (2001) Partial excision of the scaphoid: is it ever indicated? Hand Clin 17:687–695CrossRefPubMed

22.

Bain G, Sood A, Yeo C (2014) RSL fusion with excision of distal scaphoid and triquetrum: a cadaveric study. J Wrist Surg 3(1):37–41. https://doi.org/10.1055/s-0033-1364095CrossRefPubMedPubMedCentral

23.

Holleran AM, Quigley RJ, Rafijah GH, Lee TQ (2013) Radioscapholunate arthrodesis with excision of the distal scaphoid: comparison of contact characteristics to the intact wrist. J Hand Surg Am 38(4):706–711CrossRefPubMed

24.

McNary SM, Heyrani N, Volk I, Szabo RM, Bayne CO (2019) The effect of radioscapholunate fusion with and without distal scaphoid and triquetrum excision on capitolunate contact pressures. J Hand Surg Am 44(5):420.e1-420.e7. https://doi.org/10.1016/j.jhsa.2018.07.009CrossRefPubMed

25.

Shin EK, Jupiter JB (2007) Radioscapholunate arthrodesis for advanced degenerative radiocarpal osteoarthritis. Tech Hand Up Extrem Surg 11:180–183. https://doi.org/10.1097/BTH.0b013e3180413883CrossRefPubMed

26.

Galvis EJ, Kumar KK, Özyurekoglu T (2013) Radioscapholunate arthrodesis using low-profile dorsal Pi plate. Tech Hand Up Extrem Surg 17:80–83. https://doi.org/10.1097/BTH.0b013e318280e9ccCrossRefPubMed

Title: Outcomes after radioscapholunate arthrodesis for intra-articular malunion of distal radius fractures
Authors: Yasser Safoury
Ahmed Afifi
Ahmed Farghaly
Omar Khalid
Publication date: 23-04-2024
Publisher: Springer Paris
Keywords: Osteoarthrosis
Osteoarthrosis
Distal Radius Fracture
Published in: European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-03934-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcomes after radioscapholunate arthrodesis for intra-articular malunion of distal radius fractures

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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