Outcomes After Resection of the Radial Column Bones of the Wrist
Loukia K. Papatheodorou, MD, Travis W. Littleton, MD and Dean G. Sotereanos, MD, Orthopaedic Specialists - UPMC, University of Pittsburgh, Pittsburgh, PA
Trapezium resection for thumb carpometacarpal (CMC) joint arthritis and scaphoid excision with four-corner (intercarpal/ midcarpal) arthrodesis for wrist arthritis, scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC), are very common procedures in the population. There are numerous studies on the outcomes after trapezium resection for CMC arthritis and scaphoid excision with four-corner arthrodesis for wrist arthritis in isolation. However, the long-term outcomes after resection of the radial column of carpal bones: both scaphoid and trapezium are limited. The purpose of this study was to report the mid to long-term outcomes after resection of the radial column bones of the wrist, trapezium and scaphoid.
Materials & Methods
We retrospectively reviewed 9 patients with resection of the radial column of carpal bones. All patients underwent two separate surgical procedures of the wrist (trapezium resection and scaphoid excision with four-corner arthrodesis). Seven patients had first trapezium resection for thumb CMC joint arthritis and at a mean of 40 months later (range, 25-62months), they underwent scaphoid excision with four-corner arthrodesis for wrist arthritis. While, two patients underwent first scaphoid excision with four-corner arthrodesis and later, at a mean of 31 months (range, 29-33months), trapezium resection. There were three women and six men with a mean age of 58 years (range, 51-66 years) at the time of first surgery. All patients were evaluated clinically and radiographically. Functional outcome was assessed with a pain VAS scale, measurement of grip strength, key pinch strength and range of motion. Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS) were assessed.
Mean follow-up after the second operation was 82 months (range 43-142 months). All clinical parameters demonstrated improvement at final follow-up. There was a significant improvement in mean pain levels from 8.7 preoperatively to 0.4 postoperatively. Grip strength increased on average from 9 kg preoperatively to 14 kg postoperatively. Mean key pinch strength improved from 3.1 kg preoperatively to 4.8 kg postoperatively. The mean DASH and mean MMWS significantly improved postoperatively. No patient had instability of the wrist postoperatively. No reoperations were required during the follow-up period.
The results of resection of the radial column bones of the wrist are relatively unknown. Based on our study, excision of the trapezium and scaphoid have no detrimental effect on clinical outcome and satisfactory outcomes can be expected.
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