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Arthroscopic Radial Styloidectomy for Scapholunate Advanced Collapse and Scapholunate Nonunion Advanced Collapse Wrists
Anna Walden, DC; Palmer Center for Chiropractic Research; Tyson Cobb, MD; Orthopaedic Specialists, PC
Orthopaedic Specialists, Davenport, IA, USA

Radial styloidectomy for scaphoid nonunion advanced collapse (SNAC) was first reported in the mid 1990’s. Thereafter two cadaveric studies raised concerns regarding the development of carpal instability and ulnar translation. More recently a resurgence of interest has occurred with several reports of arthroscopic radial styloidectomy (ARS) for both scapholunate advanced collapse (SLAC) and SNAC wrists. Nevertheless, little data are available. The purpose of this study was to report the early results of ARS for SLAC and SNAC wrists.

Methods

Data were collected prospectively on 13 patients presenting with SLAC or SNAC wrist who underwent ARS. Subjective and objective data were collected preoperatively and at postoperative intervals of 1, 3, 6, and 12 months by an occupational hand therapist. Data collected at each time interval included wrist range of motion, grip strength, disabilities of arm, shoulder, and hand (DASH) questionnaire (0-100, higher score = greater disability) and numeric rating scale (NRS) for pain (0-10; 0 = no pain, 10 = worst possible pain). Patients ranked satisfaction (0-5; 0 = not at all satisfied, 5 = completely satisfied). Postoperative radiographs were evaluated to determine the amount of bone resected. Institutional review board (IRB) approval was obtained.

RESULTS

One patient failed and underwent revision surgery for persistent pain. Mean age was 56 years (range 39 - 78). Average follow-up was 16 months. There were 10 males and 2 females.

The dominant hand was involved in 6 cases. Preoperative indication was SNAC in 2 cases and SLAC in 10 cases. Two cases involved worker’s compensation claims. Mean pain score improved from 7 preoperatively to 2, 2, 1 and 1 at 1, 3, 6, and 12 month postoperative follow-up respectively. Mean grip strength was 19kg preoperatively and 24kg postoperatively. Mean 1 year satisfaction score was 4.7. Mean flexion was 40° preoperatively, 47° at 6 months and 50° at 1 year. Mean extension was 50° preoperatively, 51° at 6 months, and 58° at 1 year. Preoperative radial-ulnar deviation arc was 35° compared to 44° at 1 year. Tourniquet time averaged 36 minutes (range 27 to 45). Mean amount of styloid resected was 12mm.

CONCLUSION

Short-term analysis suggests that ARS for SNAC and SLAC wrist results in excellent range of motion, satisfaction and pain control. Pain improves rapidly and does not change significantly after 6 months. Continued surveillance is required to determine long term outcome.


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