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Comparison of Early Outcomes and Complications of Scaphoid Excision and Capitolunate Arthrodesis with Screws versus Staples
Mark Tait, MD; John W. Bracey, MD; Daniel R Lewis, MD; Glenn Gaston, MD; Bryan Loeffler, MD
OrthoCarolina Hand Center, Charlotte, NC
Introduction: The purpose of this study is to assess the early outcomes of scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) treated with scaphoid excision and capitolunate arthrodesis using either screws or staples. We hypothesize that the two groups will have similar rates of fusion and early complications.
Materials & Methods: Our institution’s claims database was queried using the current procedural terminology (CPT) codes for intercarpal fusions done by a single surgeon. Medical records were reviewed to identify patients with the diagnosis of SLAC or SNAC treated with scaphoid excision and capitolunate fusion. The following data was collected: demographics, preoperative diagnosis, fixation type, concomitant procedures, complications, and need for additional surgery. Fusion was assessed via plain radiographs or computed tomography (CT) scans when available.
Results: Twenty-six patients with 27 capitolunate fusions met the study eligibility criteria. The average patient age was 48 years (range 17-80 years), and 25 of the 26 patients were male. There was an average of 10 months follow up. Nineteen (70%) of the capitolunate fusions were performed for the diagnosis of SLAC, while 8 (30%) were performed for SNAC. Capitolunate arthrodesis was performed with staples in 16 (59%) cases, while screws were used in 11 (41%) cases. There was a 93% (25/27) union rate with both nonunions occurring in the screw group (2/11). All patients in the staple group (16/16) resulted in successful fusion. Three patients (27%) in the screw group had hardware related complications with screw backout into the radiocarpal joint. Impingement of the hardware on the dorsal lip of the radius was identified in 1 patient (6%) in the staple group.
Conclusion: In this patient population, the treatment of SLAC and SNAC with scaphoid excision and capitolunate arthrodesis resulted in a high rate of fusion (25/27). When comparing internal fixation with screws versus staples, we found a higher risk of nonunion with the use of screws (2/11). All patients treated with staples resulted in successful arthrodesis. Additionally, we noted screws to have a higher rate of hardware complications due to early screw backout (3/11). The incidence of hardware complications in staples was low with dorsal impingement seen in a single case (1/16). Overall, the use of staples for capitolunate fusion appears to result in successful fusion with few hardware related complications.
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