| Abstract [eng] |
Background / objective At the Vilnius University Department of Orthopaedics, Traumatology and Plastic Surgery midcarpal arthrodesis is used for the treatment of posttraumatic carpal collapse. The aim of the study was to evaluate late postoperative results concerning midcarpal arthrodesis and determine the suitability of the method for the treatment of scaphoid pseudoarthrosis. Methods In this study patients surgically treated for scaphoid pseudarthrosis at Vilnius University Emergency Hospital from 1992 till 2002 were analyzed. The object of the study was scaphoid nonunion advanced collapses (SNAC wrist). In assessing the late results of midcarpal arthrodesis, 31 patients took part. The age of pseudarthrosis varied from 1 to 32 years. The follow-up time ranged from 1 to 7 years. Movement of the carpal joint was assessed by the method of "neutral zero". Grip strength was measured with a Jamar II dynamometer. PA and lateral X-rays were analyzed. Scaphoid pseudarthroses were classified according to S. L. Filan and T. J. Herbert and Mayo. In PA X-rays carpal height was measured by the Youm index. In lateral X-ray views, angles between the carpal bone longitudinal axes were measured. In the cases when the angle between the scaphoid and the lunate was greater than 70°, between the radius and the lunate greater than 10°, between the capitate and the lunate less than 10°, the condition was called dorsal intercalated segment instability (DISI). Carpal height reduction due to scaphoid pseudoarthrosis was called scaphoid nonunion advanced collapse (SNAC wrist). Posttraumatic carpal collapse was divided into 3 stages. The patient's daily activities and general quality of life were estimated with the DASH (Disability of arm, shoulder, hand) questionnaire. Pain was evaluated by a visual analogue scale (VAS 0–100). Indications for midcarpal arthrodesis were D4 type scaphoid pseudarthrosis according to S.L. Filan and T. J. Herbert as well as to SNAC. Results 1. Pain significantly decreased in comparison with the preoperative situation (p < 0.001). 2. The flexion–extension ROM increased significantly (p = 0.009) and reached 52% of healthy hand flexion-extension range. 3. The abduction–adduction ROM increased significantly (p < 0.001) and reached 57% of healthy wrist abduction-adduction movement. 4. Grip strength increased significantly (p < 0.001) and was equal to 72% of the opposite side. 5. Posttraumatic carpal collapse was diagnosed in 30 cases (97%). The severity of the SNAC correlated significantly with the late results. The grade of posttraumatic carpal collapse correlated with flexion–extension movement range postoperatively (p = 0.008), grip strength after operation (p = 0.005), pain scale (p = 0.004). 6. The total DASH score reached 28.9 ± 12.8. A reliable relation was noted between this questionnaire results and pain scale (p = 0.001), injured wrist grip strength after operation (p = 0.006). 7. Gender, age, dominated arm disability, pseudarthrosis age, postoperative period duration, pseudarthrosis localization, pseudarthrosis classification according to S. L. Filan and T. J. Herbert, complete or partial scaphoid excision had no influence on the results. 8. Pseudoarthrosis type correlated with pseudoarthrosis age and localization (p < 0.001). Conclusions Midcarpal arthrodesis is a reliable method of treatment of scaphoid nonunion advanced collapse. Midcarpal arthrodesis results directly depend on the grade of posttraumatic collapse. |
