Radioscapholunate arthrodesis - a prospective study

Abstract

The purpose of this prospective study was to evaluate pain levels, range of motion, patient activity and satisfaction after radioscapholunate (RSL) arthrodesis. This was in association with distal scaphoid excision and complete resection of the triquetrum. The non-union rate for radioscapholunate arthrodesis was examined and the results compared with previous studies. Twenty-three patients (14 males and nine females) with an average age of 47 (range 26-73) years underwent RSL fusion for post-traumatic osteoarthritis, rheumatoid arthritis and Kienböck's disease of the lunate with a mean follow-up of 32 (range 13-70) months. The absolute prerequisite for any of these groups of patients was a functional midcarpal joint which was assessed pre-operatively with radiographs and intra-operatively prior to RSL fusion. The average flexion to extension motion changed from 66 degrees to 57 degrees . The ulnoradial range of motion also increased to 43 degrees from a pre-operative value of 22 degrees . The patients visual analogue pain scores reduced from an average of 64 to 28 (p = 0.01). Nineteen patients had no restriction in activity and all but one was satisfied with the outcome. All patients remained in full time employment with ten returning to some form of sport. RSL fusion with excision of the distal pole of the scaphoid and the entire triquetrum led to minimal reduction in the flexion-extension arc of motion and an increase in the ulnoradial arc. There was also good pain relief and maintenance of a patient's function. Memory staples are also an effective method of securing fusion in the wrist obtaining similar results to that seen in forefoot surgery.