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Functional and Radiological Outcome after Reduction-Association of the Scapholunate
Ali Izadpanah, MSc, MD, FRCSC1; William Aibinder, MD2; Bassem T. Elhassan, MD2
1McGill University Health Centre, Montreal, QC, Canada; 2Mayo Clinic, Rochester, MN

Purpose: Scapholunate dissociations being the most common type of carpal instability are challenging problems to address. Irreparable tears are common causes of mechanical wrist pain and many times the soft-tissue procedures are not able to reliably restore and preserve normal carpal alignment. The reduction-association of scapholunate (RASL) procedure to address patients without arthritis has been described previously with variable results. Thus, we sought to review the long-term outcome of patients undergoing RASL procedure to address chronic non-repairable scapholunate dissociation in our institution.

Method: A retrospective review of 12 patients undergoing RASL with an average of 24.06 months follow up (4-43 months) was performed. The visual analogue score (VAS), wrist range of motion, grip and pinch strength, postoperative complications, and radiographic parameters were recorded. Statistical analysis using SPSS 22.0 (IBM™) was performed and p<0.05 was considered statistically significant.

Results: All patients had Geissler stage III (2 patients; 16.7%) or stage IV (10 patients; 83.3%). The postoperative VAS has improved to 3.6 from 6.2. The grip and pinch strength had decreased to 28.6±17.3 kg and 8.3±6.4 kg from 34.8±19.3 kg and 14.7±12.2 kg, corresponding to 82.2% and 56.5% of preoperative values, respectively. The scapholunate (SL) interval at final follow up had decreased from 4.5±2.1 mm to 2.67±1.37 mm (p=0.007). The SL angle was stable at final radiographs (53.97±17.91 compared to 51.5±13.9 at final follow up). Flexion and Extension had decreased from 63.28º±12.92º and 61.5º ±14.2 º to 41.4º±20.46º and 52.8º ±17.3º, respectively (p<0.05). Postoperative Disability of the Arm, Shoulder, and Hand scores were 15.3±11.1. All patients other than two had planned removal of their screws at average of 18.5±15.2 months (2.4-43.2 months). Seven patients (58.3%) developed wrist arthritis (five SLAC stage II and three SLAC stage III). Two underwent partial wrist fusion. Age, sex, preoperative SL interval, SL angle, Geissler classification, preoperative range of motion or strengths did not affect the final outcomes.

Conclusion: RASL can substantially decrease the scapholunate diastasis; however it was not able to provide stability of the SL interval with many requiring secondary procedures for screw removal secondary to loosening, or partial wrist fusions. Majority of patients developed scapholunate advance collapse at final follow-up. Future long-term studies are recommended to assess and compare RASL to soft tissue reconstruction procedures to address chronic scapholunate instabilities.

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