Capitolunate Arthrodesis for Treatment of Scaphoid Nonunion Advanced Collapse (SNAC) Wrist Arthritis

Abstract

The aim of the study was to evaluate results of capitolunate arthrodesis for the treatment of post traumatic degenerative SNAC wrist disorders. A capitolunate arthrodesis was performed on 12 patients, three women and nine men, of 44 years in average (28-66 years). Ten patients were manual workers; dominant side was involved in seven cases with no history of previous operation. Fixation of the arthrodesis was performed with headless compression screws. Patients were reviewed at 37.4 months of average follow up (range; 12-47 months). Mayo score equal to 82.8 points. Radiolunate and capitolunate angles were decreased of 6 and 8°respectively at the final follow up radiograph compared to preoperative values. The Ten manual worker patients were able to return to their previous professional activities and the other two patients were retired but they resume their sports and recreational activities. With the advent of headless compression screws the capitolunate arthrodesis gained a higher union rate, short operative time and short rehabilitation period. In the present study the capitolunate arthrodesis allowed restoring a stable functional wrist in the 12 patients reviewed. It is a satisfactory therapeutic alternative to four corners fusion for SNAC wrist with osteoarthritis.

Retrospective Comparison of Capitolunate Arthrodesis Using Headless Compression Screws Versus Nitinol Memory Staples for SLAC and SNAC Wrist: Radiographic, Functional, and Patient-Reported Outcomes

“…1,2 These higher nonunion rates have been attributed to poor fixation in earlier devices and more recently are reported as low as 0% to 20% with compression screw fixation (Figure 4). 3-5,7,19 Our nonunion rate of 3% in the staple group is consistent with recent reports in the literature. 4,16,19 Ronchetti and Topper 16 presented their technique and results of capitolunate fusion using nitinol memory staples, which resulted in fusion in all cases (7 of 7) with no evidence of dorsal impingement or other hardware-related complications.…”

Capitolunate Arthrodesis versus Four-corner Arthrodesis in Scaphoin Nonunion Advanced Collapsed Wrist Treatment

“…Contraindications for this technique are radiolunate compromise and ulnar translocation of the wrist. 9 The main complications of four-corner arthrodesis are nonunion (5.5%), hardware-related complications (3.3%), and dorsal impingement or lunate malposition (2.6%). [9][10][11][12] The complications may be related to the surgical technique, to the quality of the bone grafting, and to the fixation hardware used.…”

“…9 The main complications of four-corner arthrodesis are nonunion (5.5%), hardware-related complications (3.3%), and dorsal impingement or lunate malposition (2.6%). [9][10][11][12] The complications may be related to the surgical technique, to the quality of the bone grafting, and to the fixation hardware used. Consequently, the literature demonstrates variable nonunion rates in a series of four-corner arthrodesis performed with dorsal plate.…”

“…13 The reported long-term results are a flexion-extension of 55% of the contralateral side, grip strength of 80% of the contralateral side, and absence of pain in between 80 and 90% of the patients. 9,13,14,16 The method of internal fixation described for four-corner arthrodesis involves Kirschner wires, staples, screws and dorsal plates. The nonunion rate for the 1 st 3 methods of fixation ranges from 3 to 18%, and in the case of dorsal plates, from 16 to 62%.…”

“…19 Since the introduction of compression screws, the reported nonunion rates were drastically reduced, reaching 8% in the series reported by Goubier et al 6 and by Delclaux et al, 12 and 0% in the series reported by Gaston et al and by Hegazy. 7,9 In addition, a shorter operative time and less dissection of the soft tissue make this procedure an appealing alternative to four-corner arthrodesis. 19 Regarding the functional outcome in capitolunate arthrodesis, flexion-extension was reported to range between 48 and 53% of the contralateral side, and the grip strength from 61 to 70% 8,18 Some technical refinements have been proposed, such as excision of the triquetrum to avoid ulnar impaction, although increasing radiolunate contact.…”