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Study shows successful long-term results of distal scaphoid resection
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SAN DIEGO — Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion has satisfactory long-term results, according to the results of a study presented here.
 Matthew M. Malerich |
Matthew M. Malerich, MD, followed up on a paper he presented in 1995, by revisiting his distal scaphoid resection patients. He presented his latest results at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
At the time of the original presentation in 1995, the average follow-up was 49 months. The audience asked for further follow-up data at that time, so Malerich aimed to demonstrate that satisfactory results could be maintained at longer follow-up.
“Here is the problem,” Malerich said. “You have a scaphoid nonunion, failed bone grafts, arthritis … and our proposed solution was just to excise the distal fragment.”
A long-term follow-up
Eighteen of Malerich’s original 19 patients were re-reviewed at follow-up between 11 and 21 years, with a mean follow-up of 15 years. This included repeat examinations and radiographs.
“The controversy here was whether the wrist would collapse, so we paid close attention to whether the radiolunate angle or [dorsal intercalated segment instability] deformity would regress, as well as whether the wrist would collapse,” Malerich said, adding he was also on the lookout for the development of arthritis.
Of the 18 patients, 17 remained satisfied with the results of the procedure. Range of motion, he added, was maintained at the same degree when compared to the 1995 study results.
Flexion-extension arc was 90º, with radial-ulnar deviation arc reaching 39º. Although grip strength decreased 20%, Malerich said, it did so symmetrically. He was able to report no change in the radiolunate joint angle or revised carpal height ratio.
Satisfactory results
Malerich said approximately a third of his patients did have “some degree” of new capitolunate joint space narrowing, but added this was asymptomatic. Radiolunate and residual radial scaphoid joints did not develop arthrosis, he noted.
One patient in the study was reported to have undergone a proximal row carpectomy.
Overall, Malerich said, the long-term results are satisfactory. A total of 94% patients remained satisfied with the results of the study, no additional joints developed arthritis and no further wrist collapse occurred.
When Malerich was asked if there was a “size limit” to the distal pole beyond which he would not recommend excising it, Malerich responded there was not.
“I think the key to this operation is the size,” he said. “To make this operation work, I usually wait until the patient loses wrist extension and radial deviation. It takes about 12 years. The capsular structures contract, and that is why do not get further collapse after the operation.”
Reference:
- Malerich MM, et al. Distal scaphoid resection for arthritis secondary to scaphoid nonunion: A twenty year experience. Paper 337. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
Certainly for those of us who have done this before, particularly in the relatively active population around age 30, 40, 50 [years] or older, this is a very straightforward procedure that has very, very good outcomes.
Some of the questions from the audience – as well as some of my own – concern just how much of the scaphoid you can resect before the wrist may become unstable. Nobody has really answered that question.
– Fraser J. Leversedge, MD
Moderator
Disclosure: Leversedge is a paid consultant for, owns stock in and receives research or institutional support from Orthohelix Surgical Designs. He also receives royalties from Wolters Kluwer Health – Lippincott Williams & Wilkins.
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