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The Effect of Radioscapholunate Fusion with and without Distal Scaphoid and Triquetrum Excision on Capitolunate Contact Pressures
Nasser Heyrani, MD; Christopher Omar Bayne, MD; Dora Anna Rendulic, MD; Sean McNary, PhD
UC Davis Medical Center, Sacramento, CA
Introduction: For patients with isolated radiocarpal arthritis and sparing of the mid-carpal joint, radioscapholunate (RSL) can preserve motion and help alleviate pain. Scaphoid and triquetrum excision are sometimes performed at the time of RSL fusion to improve wrist motion. To date, no study has compared the affect of RSL fusion with and without scaphoid and triquetrum excision on adjacent carpal articulations.
Materials and Methods: Five wrist specimens were dissected of all superficial soft tissues. The carpus was exposed via a ligament sparing capsulotomy and RSL arthrodesis was performed using 2.4-mm distal radius plates with locking screws. Ultralow Fuji prescale pressure-sensitive film¨ (Sensor Product, Inc., East Hanover, NJ) was inserted into the capitolunate joint. Contact area, pressure, and force at the midcarpal joint was measured after the application of a 35N axial force in specimens before RSL fusion, specimens after RSL fusion, specimens after RSL fusion with distal scaphoid excision, and specimens after RSL fusion with distal scaphoid and triquetrum excision.
Results: The mean contact forces before fusion, after RSL fusion alone, after RSL fusion with distal scaphoid excision, and after RSL fusion with distal scaphoid and triquetrum excision were 5.2 N (S.D. 0.9), 8.9 N (S.D. 1.5), 9.9 N (S.D. 2.0) and 7.1 N (S.D. 1.8), respectively. Contact area and force were significantly increased after RSL fusion with and without distal scaphoid excision. Triquetrum excision resulted in intermediate contact area and force. While there was no significant difference in contact pressure between specimens after RSL fusion, RSL fusion with scaphoid excision, or RSL fusion with scaphoid and triquetrum excision, pressures trended upward with each subsequent procedure.
Conclusion: Motion increasing procedures performed at the time RSL fusion may increase midcarpal joint contact force, area, and pressure. While the clinical significance of these findings is unknown, surgeons should take this information into consideration when counseling their patients on the possibility of developing adjacent joint arthritis in the future.
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