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Long-term study shows durability of distal scaphoid resection

Issue: October 2011

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Michael C. Vance

LAS VEGAS — Distal scaphoid resection arthroplasty provides good long-term results for patients with scaphoid nonunion, according to a study with up to 23 years follow-up presented here at the 2011 Annual Meeting of the American Society for Surgery of the Hand.

“Distal scaphoid resection is a simple and safe procedure,” study author Michael C. Vance, MD, said during his presentation. “It provides rapid recovery, a high level of patient satisfaction [and] predictable results, and excellent treatment options remain available if the procedure should fail.”

For their retrospective study, Vance and colleagues Louis W. Catalano III, MD, and Matthew M. Malerich, MD, performed a longer follow-up of 18 patients who underwent distal scaphoid resection for arthritis secondary to scaphoid nonunion and had their results with an average follow-up of 49 months originally published by Malerich and colleagues in 1999. For this latest study, the patients had an average follow-up of 14 years.

The investigators found that range of motion was maintained at levels found in the 1999 study. “Grip strength decreased 17%, but did so symmetrically,” Vance said. “There was no significant progression of deformity or carpal collapse. No cases regularly required narcotic pain medications, and patient satisfaction was 96% since the original publication and 89% overall.”

Five patients developed asymptomatic capitolunate arthritis. The investigators found no developments of radiolunate arthritis or progression of radial scaphoid arthritis. Overall, two patients required revision procedures.

Reference:

• Vance M C, Catalano LW, Malerich MM. Distal scaphoid resection for arthritis secondary to scaphoid nonunion: A 20-year experience. Paper #2. Presented at the 2011 Annual Meeting of the American Society for Surgery of the Hand. September 8-10. Las Vegas.
• Disclosure: Vance has no relevant financial disclosures.

The usual salvage options for scaphoid nonunions and collapse — proximal row carpectomy, scaphoid excision four-corner fusion and total wrist fusion — are major procedures. Many patients want something simple, early return to activities and same motion, just not the same pain.

This is an excellent study because they followed up the exact same cohort of patients in the original publication by Malerich and colleagues in New York in 1999. Amazingly, 18 of the 19 patients were available for follow-up. [At] an average follow-up of 14 years, only two patients required a salvage procedure and the others were pain free and satisfied. Flexion-extension was 80% of the normal wrist, and grip strength remained good at 76% of the normal wrist. Although there were some progressive arthritic changes on X-rays, clinical intervention was not necessary.

Distal scaphoid resection is a great option because it burns no bridges, and the usual salvage procedures can still be done later. It’s been said that there’s nothing worse for a procedure than long-term follow-up. In this case, that is not true. The authors have shown that at 23 years out, distal scaphoid resection for scaphoid nonunion is still a worthwhile option.

— James Chang, MD
Session moderator

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