Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists

When treating the degenerative arthritis that follows scapholunate instability or scaphoid pseudarthrosis, excision of the scaphoid must be combined with a stabilisation of the midcarpal joint. Two alternatives have been proposed for that purpose: fusing the lunate, triquetrum, capitate and hamate (...

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Bibliographic Details
Published in:The Journal of hand surgery, European volume European volume, 2009-10, Vol.34 (5), p.603-608
Main Authors: FERRERES, A., GARCIA-ELIAS, M., PLAZA, R.
Format: Article
Language:English
Subjects:
Adult
Aged
Arthrodesis - methods
Biological and medical sciences
Carpal Joints
Diseases of the osteoarticular system
Female
Follow-Up Studies
Fractures, Ununited - diagnostic imaging
Fractures, Ununited - physiopathology
Fractures, Ununited - surgery
Hand Strength
Humans
Joint Instability - diagnostic imaging
Joint Instability - physiopathology
Joint Instability - surgery
Male
Malformations and congenital and or hereditary diseases involving bones. Joint deformations
Medical sciences
Middle Aged
Orthopedic surgery
Osteoarthritis
Proprioception
Radiography
Range of Motion, Articular
Reproducibility of Results
Scaphoid Bone - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Outcome
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Summary:When treating the degenerative arthritis that follows scapholunate instability or scaphoid pseudarthrosis, excision of the scaphoid must be combined with a stabilisation of the midcarpal joint. Two alternatives have been proposed for that purpose: fusing the lunate, triquetrum, capitate and hamate (four corner fusion), 4CF; or limiting the arthrodesis to the lunate and capitate, preserving or excising the triquetrum. Previous reports have attributed a high level of complications to lunocapitate arthrodesis, mainly in respect of nonunion. We have reviewed 17 patients who had been treated with a lunocapitate fusion, after an 8 to 12-year follow-up period, and found similar results compared with 4CF, even with a major degree of motion in ulnar-radial deviation. Recent work on the innervation of the radiotriquetral ligaments has given relevance to the preservation of lunotriquetral motion in maintaining proprioception. Also if the triquetrum is excised to gain more motion, the proprioceptive role of the radiotriquetral ligaments is compromised.
ISSN:1753-1934
2043-6289
DOI:10.1177/1753193409105683