Triscaphoid arthrodesis and its complications (2023)

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The Journal of Hand Surgery

Volume 13, Issue 6,

November 1988

, Pages 844-849

Abstract

Carpal instability and/or arthrosis of the scaphotrapezial joint were treated with scaphotrapezio-trapezold arthrodesis in 19 hands. Healing failed primarily in five hands as determined by conventional or computed tomography. No correlation was found to surgical methods or immobilization time. Surgical revision had to be done for four of the nonunions. These complications do not correspond to those described in the literature but draw attention to some adversities encountered in the use of this method.

References (13)

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Cited by (51)

  • Scaphotrapeziotrapezoid Arthrodesis: Systematic Review

    2022, Journal of Hand Surgery

    Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of complications and outcomes after STT arthrodesis.

    Several major databases were used to perform a systematic literature review inorder to obtain articles reporting complications and outcomes following STT arthrodesis.The primary purpose was to identify rates of nonunion and conversion to totalwrist arthrodesis. Secondary outcomes included wrist range of motion, grip strength, and Disabilities of the Arm Shoulder and Hand scores. A multivariable analysis was performed to evaluate factors associated with the primary and secondary outcomes of interest.

    Out of the 854 records identified in the primary literature search, 30 studies wereincluded in the analysis. A total of 1,429 procedures were performed for 1,404 patients. The pooled nonunion rate was 6.3% (95% CI, 3.5–9.9) and the rate of conversion to total wrist arthrodesis following the index STT was 4.2% (95% CI, 2.2–6.7). The mean pooled wrist flexion was 40.7° (95% CI, 30.8–50.5) and extension was 49.7° (95% CI, 43.5–55.8). At final follow-up, the mean pooled grip strength was 75.9% (95% CI, 69.3–82.5) of the nonsurgical contralateral hand. Compared with all other known indications, Kienbock disease had a statistically significant lower nonunion rate (14.1% vs 3.3%, respectively). Mixed-effects linear regression using patient-level data revealed that increasing age was significantly associated with complications, independent of occupation and diagnosis.

    Our study demonstrated a low failure rate and conversion to total wrist arthrodesis after STT arthrodesis and acceptable postoperative wrist range of motion and strength when compared to the contralateral hand.

    Therapeutic IV.

  • Scaphotrapeziotrapezoid arthrodesis for isolated osteoarthritis: results at a mean 8 years’ follow-up

    2021, Hand Surgery and Rehabilitation

    The aim of this retrospective study was to report medium- to long-term outcome of scaphotrapeziotrapezoid (STT) arthrodesis with staple fixation to treat painful isolated osteoarthritis (OA). Twenty-one consecutive patients (22 wrists) who had undergone STT arthrodesis were retrospectively reviewed by an independent examiner. Clinical and radiological evaluation was performed. At a mean follow-up of 8 years (range 2–20 years), pain levels were significantly decreased, and functional scores were significantly improved. Grip and pinch strength were 86% and 82% of those of the contralateral side. Wrist range of motion in flexion-extension and radial-ulnar deviation was significantly less than on the contralateral side at last follow-up (104° vs. 131° and 38° vs. 55°, respectively). Non-union was found on X-ray in 4 wrists (18%), but in 2 cases showed as partial non-union on CT, with complete scaphotrapezial consolidation; 1 of the 4 wrists required surgical revision. Another patient was re-operated on for symptomatic external staple displacement without non-union. There were 8 cases (36%) of radiographic narrowing of the styloscaphoid joint space; contact between the staple and styloid was found in all 8 cases. Four patients (18%) had narrowing of the scaphocapital joint space; protrusion of the proximal part of the staple into the joint space was noted in all 4 wrists. No differences were found for the radioscaphoid, capitolunate and scapholunate angles before and after surgery. STT arthrodesis with staple fixation to treat isolated STT OA led to a significant reduction in pain, with improved strength and functional scores. To avoid styloid impingement, we recommend systematic styloidectomy. Complete non-union seems to be overestimated on radiographs. Partial non-union with scaphotrapezial union should not be considered as a complication.

    IV

    Le but de cette étude rétrospective était de rapporter les résultats à moyen et long termes de l'arthrodèse scapho-trapézo-trapézoïdienne (STT) avec fixation par agrafes dans le traitement de l'arthrose STT isolée et douloureuse. Vingt-et-un patients (22 poignets) consécutifs ayant subi une arthrodèse STT ont été revus rétrospectivement par un examinateur indépendant. Il a réalisé une évaluation clinique et radiologique. Au suivi moyen de 8 ans (intervalle 2–20), les douleurs avaient été diminuées et les scores fonctionnels améliorés de manière significative. La force de préhension et de la pince pouce-index était de 86% et 82% comparativement au côté opposé. L'amplitude des mouvements du poignet en flexion-extension et en déviation radio-ulnaire était significativement inférieure à celle du poignet controlatéral au dernier recul (respectivement 104° contre 131° et 38° contre 55°). La radiographie a révélé une pseudarthrose dans 4 cas (18%), mais deux d'entre elles étaient en réalité partiellement consolidées sur les images scannographiques avec notamment une consolidation complète de l’interligne scapho-trapézien ; un des quatre patients a nécessité une révision chirurgicale. Un autre patient a été réopéré pour des douleurs secondaires au recul d'une agrafe, sans pseudarthrose. Dans huit cas (36%) a été trouvé sur la radiographie un pincement de l’interligne stylo-scaphoïdien; un contact entre l'agrafe et le processus styloïde était présent dans tous les cas. Quatre patients (18%) présentaient un pincement de l’interligne scapho-capital ; nous avons, pour chacun d’entre eux, trouvé une protrusion de la partie proximale de l'agrafe dans l’interligne. Aucune différence n'a été constatée concernant les angles radio-scaphoïdien, capito-lunaire et scapho-lunaire avant et après l'intervention. L'arthrodèse STT avec fixation par agrafe dans le traitement de l'arthrose STT isolée entraîne une réduction significative de la douleur, avec une amélioration de la force et des scores fonctionnels. Afin d’éviter tout conflit avec le matériel, nous conseillons la réalisation systématique d’une styloïdectomie radiale. Le taux de pseudarthrose semble être surestimé sur les radiographies standards. Une consolidation partielle respectant la fusion scapho-trapézienne ne doit pas être considérée comme une complication.

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    IV

  • Functional outcomes after surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis: Retrospective single-center 24-case series

    2020, Hand Surgery and Rehabilitation

    Isolated scaphotrapeziotrapezoid (STT) osteoarthritis has functional consequences on the wrist. The main objective of our study was to evaluate the functional outcomes of patients managed surgically during the last 12 years at the Toulouse University Hospital, regardless of the surgical technique used, for isolated STT osteoarthritis. We performed a single-center retrospective observational study using the CCAM database. The inclusion criteria were patients treated surgically for isolated STT osteoarthritis who did not respond to conservative treatment, with at least 6 months of clinical and radiological follow-up. Twenty-four patients were treated between 2006 and 2018. Partial arthroplasty of the distal pole of the scaphoid with or without interposition and total trapeziectomy had been performed on these patients. The mean follow-up was 79±46.8 months. The wrist range of motion (ROM) and the Kapandji score were not significantly reduced postoperatively. The mean postoperative QuickDASH score was 29.15±8.46. The mean pain assessed using a visual analog scale was 6.6±1.17 preoperatively versus 1.25±1.51 postoperatively (P=0.003). Statistical subgroup analysis found no predictive factor for a better postoperative QuickDASH score, and no surgical technique was superior at halting the progression of intracarpal misalignment and postoperative ROM. Surgical treatment of isolated STT osteoarthritis resistant to conservative treatment leads to significant functional improvement, particularly in terms of pain, without altering the wrist's overall mobility.

    L’arthrose scapho-trapézo-trapézoïdienne (STT) isolée engendre un retentissement fonctionnel sur le poignet. L’objectif principal de notre étude était d’évaluer les résultats fonctionnels des patients pris en charge chirurgicalement au CHU de Toulouse durant les douze dernières années, quelle que soit la technique chirurgicale utilisée, pour une arthrose STT isolée. Nous avons réalisé une étude observationnelle rétrospective monocentrique en utilisant la base de données CCAM. Les critères d’inclusion étaient : patient pris en charge chirurgicalement pour une arthrose STT isolée résistant au traitement médical, avec un suivi clinique et radiologique supérieur à 6mois. Vingt-quatre patients ont été pris en charge chirurgicalement entre 2006et 2018. La résection arthroplastique partielle du pôle distal du scaphoïde avec ou sans interposition et la trapézectomie totale avaient été utilisées. Le recul moyen était de 79±46,8mois. Les mobilités articulaires du poignet et le score de Kapandji n’étaient pas diminués de manière significative en postopératoire. Le score QuickDASH moyen postopératoire était de 29,15±8,46. La douleur moyenne appréciée sur une échelle visuelle analogique était de 6,6±1,17en préopératoire contre 1,25±1,51en postopératoire (p=0,003). Une analyse statistique en sous-groupes n’a pas permis de mettre en évidence de facteur prédictif d’un meilleur score QuickDASH postopératoire, ni la supériorité d’une technique chirurgicale sur l’évolution de la désaxation intracarpienne et les mobilités postopératoires. Le traitement chirurgical de l’arthrose STT isolée résistant au traitement médical apporte une amélioration fonctionnelle non négligeable, notamment sur la douleur sans altérer les mobilités globales du poignet.

  • Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis

    2019, Orthopedic Clinics of North America

  • Treatment of scaphotrapeziotrapezoid osteoarthritis with the Pyrocardan<sup>®</sup> implant: Results with a minimum follow-up of 2 years

    2017, Hand Surgery and Rehabilitation

    The aim of this study was to report the results of arthroplasty using a mobile pyrocarbon implant (Pyrocardan®) for isolated scaphotrapeziotrapezoid (STT) osteoarthritis. The hypothesis was that this arthroplasty leads to functional improvement without carpal instability. Twenty patients (22 implants) were included with a minimum follow-up of 2 years and an average age of 59.6 years. Outcome criteria were pain (VAS scale), QuickDASH and PRWE scores, strength (grip and pinch), wrist mobility, the Kapandji index, carpal height and the capitolunar angle measured on X-rays. The preoperative data was compared to the postoperative data. The average follow-up was 3.8 years. There was a significant improvement in pain, clinical scores and pinch strength. In terms of range of motion, we found that amplitudes were maintained except for a significant decrease in wrist extension. X-rays did not show any carpal instability; carpal height was maintained and the capitolunar angle was significantly improved. No implant dislocation was reported. The good functional and radiographic outcomes, and the absence of surgical complications are evidence that the Pyrocardan® resurfacing implant is a valid option for treating STT osteoarthritis. If this arthroplasty procedure fails, another procedure can still be done. However, a long-term assessment of this technique is still needed.

    Le but de cette étude était de rapporter les résultats de l’arthroplastie par un implant libre en pyrocarbone, le Pyrocardan®, pour le traitement de l’arthrose scapho-trapézo-trapézoïdienne (STT) isolée. L’hypothèse de départ était que cette arthroplastie permettait une amélioration fonctionnelle sans déstabiliser le carpe. Vingt patients d’âge moyen 59,6ans ont été inclus, soit 22implants au total, avec un recul minimum de deux ans. Les critères d’évaluation étaient la douleur appréciée sur une échelle visuelle analogique (EVA), les scores QuickDASH et PRWE, la force de poigne (grip) et de pince (pinch), les mobilités de poignet, l’indice de Kapandji ainsi que la hauteur du carpe et l’angle capito-lunaire calculés sur radiographie. Les données préopératoires étaient comparées à celles au dernier recul. Le recul moyen était de 3,8ans. Une amélioration significative était observée sur la douleur, les scores fonctionnels et la force de pince. Les amplitudes articulaires étaient maintenues, excepté une diminution significative en extension. Les radiographies ne montraient pas d’instabilité du carpe, mais un maintien de la hauteur du carpe et une amélioration significative de l’angle capito-lunaire. Aucune luxation d’implant n’était déplorée. Les bons résultats fonctionnels et radiologiques, l’absence de complications de la technique chirurgicale font du resurfaçage par implant libre Pyrocardan® une option de choix dans l’arsenal thérapeutique de l’arthrose STT. De plus, en cas d’échec, il est toujours possible de réaliser une autre opération. Une évaluation de cette technique à long terme est cependant nécessaire.

  • The effect of the dorsal intercarpal ligament on lunate extension after distal scaphoid excision

    2012, Journal of Hand Surgery

    After a distal scaphoid excision, most wrists develop a mild form of carpal instability–nondissociative with dorsal intercalated segment instability. Substantial dysfunctional malalignment is only occasionally seen. We hypothesized that distal scaphoid excision would lead to carpal instability–nondissociative with dorsal intercalated segment instability in cadavers and that the dorsal intercarpal (DIC) ligament plays a role in preventing such complications.

    We used 10 cadaver upper extremities in this experiment. A customized jig was used to load the wrist with 98 N. Motion of the capitate and lunate was monitored using the Fastrak motion tracking system. Five specimens had a distal scaphoid excision first, followed by excision of the DIC ligament, whereas the other 5 specimens first had excision of the DIC ligament and then had a distal scaphoid excision. Rotation of the lunate and capitate was calculated as a sum of the relative motions between each intervention and was compared with its original location before intervention (control) for statistical analysis.

    Distal scaphoid excision and subsequent DIC ligament excision both led to significant lunate extension. DIC ligament excision alone resulted in lunate flexion that was not statistically significant. After DIC ligament excision, distal scaphoid excision led to significant lunate extension. Capitate rotation was minimal in both groups, verifying that the overall wrist position did not change with loading.

    Distal scaphoid excision leads to significant lunate extension through an imbalance in the force couple between the scaphotrapeziotrapezoidal joint and the triquetrum-hamate joint. The DIC ligament may serve as a secondary stabilizer to the lunocapitate joint and prevent further lunate extension with the wrist in neutral position.

    The development of a clinically symptomatic carpal instability–nondissociative with dorsal intercalated segment instability with lunocapitate subluxation after distal scaphoid excision may be due to an incompetent DIC ligament.

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    This study combined motion analysis and manual digitization of ligament attachment regions to generate predictions of carpal ligament length and implied strain during wrist motion and length changes after simulated ligamentous injury.

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    Disruption of the membranous and palmar portions of the SLL and the dorsal intercarpal ligament off the scaphoid did not result in the development of an increased 3-dimensional scapholunate gap, as measured by differences in ligament length calculations between the scaphoid and lunate. This may indicate a predynamic instability condition (before clinical signs and x-ray findings) that is stabilized by the dorsal SLL, preventing the increase in the 3-dimensional scapholunate gap. This may also support surgical treatment recommendations, which suggest that repair of the dorsal component only of the SLL will be effective. Disruption of the dorsal intercarpal ligament off the scaphoid or lunate did not result in further significant changes. Therefore, the dorsal SLL has an important role in preventing scapholunate ligament instability.

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    Hallux valgus (HV) is occasionally associated with chronic dislocation of the lesser metatarsophalangeal (MTP) joints. We have developed a novel surgical procedure to treat dislocation of the lesser MTP joints. This study aimed to describe our procedure and investigate the outcomes of surgical intervention in the treatment of HV with dislocation of the lesser MTP joints.

    Twenty-three patients (27 feet, average age: 63.6years, average follow-up: 49.5months; a minimum follow-up of 24months) underwent surgical intervention for HV and dislocation of the lesser MTP joints. Twenty-three feet had dislocation (10 feet) or subluxation (13 feet) of the second MTP joint, whereas 4 feet had dislocation of the second and third MTP joints. The surgical procedure included a distal soft-tissue procedure combined with proximal osteotomy for correction of the HV, and reconstruction of the collateral ligaments (CL) following open reduction with complete release of the capsule and the CL at the metatarsal head for dislocation of the lesser MTP joints. Outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) scale and radiological examinations.

    The JSSF score improved significantly from an average of 49.7 points preoperatively to 93.1 points postoperatively. The average HV angle and intermetatarsal angle decreased significantly from 44.6° and 18.1° preoperatively to 7.9° and 6.0° postoperatively, respectively. The average extension and flexion of the second MTP joint was 53.1° and 13.8° at the most recent follow-up, respectively. Postoperatively, no feet had dislocation of the second or third MTP joint, three had subluxation of the second MTP joint, and one had subluxation of the third MTP joint. Osteoarthritis of the lesser MTP joint had developed in two feet (7.4%) at the time of the most recent follow-up.

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    Our surgical procedure achieved significant correction of HV, a low rate of postoperative re-dislocation of the lesser MTP joints, and significant improvement of pain and function for symptomatic moderate-to-severe HV with dislocation of the lesser MTP joints.

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