ARTICLE IN PRESS WRIST 1
9.3 TREATMENT OF ADVANCED CARPAL COLLAPSE: PROXIMAL ROW CARPECTOMY (PRC) OR FOUR CORNER FUSION (FCF)?
B. Lukas Orthopa¨dische Klinik Mu¨nchen-Harlaching, Mu¨nchen, Germany Introduction: Many of untreated scaphoid non-unions or SL-ligament ruptures lead to SNAC- or SLAC wrist. In SNAC- or SLAC wrist stadium II, PRC or FCF are possible as salvage procedures. If there is already midcarpal arthrosis in stadium III, our option is limited to FCF. Patients and methods: Between July 2000 and December 2004, 64 wrists were treated because of SLAC, SNAC and radiocarpal arthrosis after intraarticular fractures of the distal radius. In 29 cases proximal row carpectomy (PRC) and in 35 cases four corner fusion (FCF) was performed. We could follow up 22 cases of PRC and 28 cases of FCF with a mean follow up of 18.4 (PRC) and 21.6 months (FCF). The mean age of the PRC group was 61, 19 patients were female, 10 male. The mean age of the FCF group was 54, 6 patients were female, 29 male. The following complications were seen: In the PRC group twice a second procedure was necessary; once an arthrodesis of the wrist and once placing a prosthesis. In the FCF group were three complications; one algodystrophy, one infection and one patient needed a second procedure (arthrodesis of the wrist). Results: In all cases signiﬁcant reduction of extension/ ﬂexion was observed wit a mean range of 681 (PRC) and 701 (FCF). Comparing the grip-strength to the nonoperated hand, we measured 25 compared to 40 kg in the PRC group and 28 compared to 46 kg in the FCF group. The reduction of pain postoperatively was almost the same in both groups. The DASH-score for the FCF group was 32 points after surgery and therefore better than the 36 points for the PRC group. Conclusion: Both procedures are good options as salvage procedures. We prefer PRC for elder patients and women and FCF for younger patients and working men. 10.1016/j.jhsb.2006.03.151
9.4 CLINICAL AND CT EVALUATION OF FOUR CORNER ARTHRODESIS WITH SPIDER CIRCULAR PLATE IN THE TREATMENT OF SLAC/SNAC WRIST
R. Sadun1, A. Pagnotta1, A. Genzini2 and M. Mastrantuono3 1 Ospedale Israelitico, Rome, Italy; 2 Ospedale S. Giovanni Addolorata, Rome, Italy; 3 Universita` La Sapienza, Rome, Italy Background: Four-corner arthrodesis with scaphoid excision has been used to reduce pain and to partially
preserve motion in patients with radioscaphoid arthritis and carpal collapse (SLAC/SNAC wrist). Four-corner arthrodesis can be performed with K-wires, screws, staples, and circular (Spiders, Hub Cups) or square plates (Diamonds). Aims: The aim of this study is to evaluate the results of 4-corner arthrodesis with scaphoid excision performed with Spiders circular plates (MBA) at 12 to 26 months, in terms of motion, strength, and pain, and to compare them with radiological ﬁndings. Material and methods: Eight patients (mean age 66.3 year), six men and two women, underwent surgery for carpal collapse. In six cases secondary to a longstanding scapholunate dissociation (SLAC wrist) and in two cases to a long-standing scaphoid non-union (SNAC wrist). All patients were treated with scaphoid excision and lunate–capitate–hamate–triquetrum arthrodesis with a Spiders plate. They have been reexamined 12 to 26 months after surgery and mobility (ROM), grip strength (Jamar), daily activities and pain (DASH questionnaire) were evaluated. Radiographs, CT scans and MRI were performed pre- and postoperatively. Results: None of the patients had pain under resting conditions; four of them had slight residual pain and two had moderate pain under stress. Grip strength increased compared to pre-operative values. Wrist extension was an average of 311, wrist ﬂexion 23.51. CT scans showed no signs of union in six patients (75%), and MRI demonstrated no progression of arthritis in the radio-lunate joint in all cases. Discussion: Scaphoidectomy with four corner arthrodesis is a reliable procedure for treating pain and for preserving partial wrist motion. In particular, the circular plate simpliﬁes the surgical technique and reduces the postoperative immobilization. The high rate of radiological non-union, although always asymptomatic, needs to be evaluated with a longer follow-up. 10.1016/j.jhsb.2006.03.152
9.5 SURGICAL OUTCOME OF RADIAL OSTEOTOMY FOR KIENBOCK’S DISEASE
D. Efstathopoulos, P. Aretaiou, A. Garbi, T. Kavalierakou, G. Katsimixas and G. Sfyras Kat Hospital, Athens, Greece Introduction: This study reports the results of a long follow-up of radial osteotomy for Kienbock’s disease and investigates whether the favourable intermediate results are ﬁnally maintained. Materials and methods: Thirty two patients who were treated with radial osteotomy for Kienbock’s disease were followed for a mean period of 12 years (range 10–16). There were 20 males and 12 females, from