Resección artroscópica del polo distal del escafoides en la artrosis escafo-trapecio-trapezoidea

Abstract

La artrosis escafo-trapecio-trapezoidea se asocia frecuentemente a una inestabilidad carpiana. En dichas ocasiones el tratamiento quirúrgico abierto mediante la resección simple del polo distal puede ocasionar un colapso carpiano. El uso de la artroscopia para la resección del polo distal del escafoides permite, no solo la resección del polo distal a través de un abordaje mínimamente invasivo, sino también la evaluación y posible tratamiento de inestabilidades carpianas asociadas. En el presente trabajo se detalla la técnica quirúrgica para realizar la resección del polo distal del escafoides de forma artroscópica a través de tres portales artroscópicos.

Introducing the “SOAC Wrist”: Scaphotrapeziotrapezoid Osteoarthritis Advanced Collapse

“…Other authors 6,22,[28][29][30] have reported the relationship of STT-OA with ligament injury and SL dissociation. Wadhwani et al 28 assessed 618 radiographs of patients with wrist pain, 43 (7%) of which presented SL ligament injury, with SL space widening greater than 4 mm.…”

“…Other procedures have also been proposed in an attempt to improve STT joint motion by reducing the local inflammatory process created by OA and the overloading of adjacent joints. 3,10,30 Isolated arthroscopic debridement with synovectomy and osteophyte resection has demonstrated good results in the short term, with 90% of satisfaction in 3 years, but its long-term evolution and the use in advanced stages of the disease are not known. 41 Another treatment option, as proposed by Garcia-Elias et al, [42][43][44] is the resection of the distal pole of the scaphoid.…”

“…It requires less immobilization time and has fewer complications than arthrodesis, but can create midcarpal instability and DISI deformity, or even worsen such problems if already existent. 30,[45][46][47] Most authors nowadays recommend the association of some type of carpal stabilization to the distal scaphoid resection. 10,[42][43][44] Some authors propose the use of metal interposition arthroplasties for such a purpose.…”

“…However, as with the open surgical modality, they have pointed out that it is not possible to remove more than 3 mm from the distal scaphoid due to the risk of causing DISI. 8,30,41,48,50 Iida et al 51 assessed 16 patients treated with such technique, all of them without previous DISI, and reported that out of 4 patients with a resection of more than 3 mm, 2 evolved to DISI. No one developed DISI in cases when less than 3 mm were resected.…”