Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up

Abstract

Objective: We intend to demonstrate the functional results of a patient with post-traumatic radiocarpal arthrosis due to a scaphoid nonunion advanced collapse who underwent surgical treatment with proximal row carpectomy and capitate resurfacing with pyrocarbon implant. Material and Methods:A 51-year-old male patient, working as a sculptor, presented to our consultation with a scaphoid nonunion advanced collapse due to a non-treated scaphoid fracture 20 years before. Clinically he had pain and radiocarpal instability. Radiographically, there was collapse of the scaphoid and lunate, advanced radiocarpal osteoarthritis and proximal migration of capitate.In 2018, he underwent proximal row carpectomy and capitate resurfacing with pyrocarbon implant through a dorsal approach. The patient was immobilized with a wrist cast for 4 weeks. physical rehabilitation started after remove of the cast. Unrestrained activities were allowed at 12 weeks after surgery. Every 6 months the patient was observed in our consultation.Results: After two and a half years of follow-up, the patient presents a presented a significant improvement on wrist pain, with an initial Visual Analogue Scale score of 9/10 and a current one of 3/10 and a satisfactory wrist mobility, with approximately 20º of extension and 30º of flexion, which allows the execution of his work activity. He refers, however, to a decrease in grip strength. On reassessment radiographs, there is a periprosthetic radiolucent line of 1mm, with progression of radiocarpal arthrosis. Conclusion:Post-traumatic radiocarpal arthrosis has a negative impact on patients' quality of life. There are several surgical treatment options varying from proximal row carpectomy, total wrist prosthesis, partial or total arthrodesis. In the present case, capitate resurfacing with pyrocarbon implant associated with proximal row carpectomy proved to be a good surgical option, with satisfactory results, especially in the reduction of pain, providing the patient wrist mobility compatible with the daily living activities.