Dorsal intercalated segmental instability associated with malunion of a reconstructed scaphoid

J Hand Surg Eur Vol. 2017 Mar;42(3):240-245. doi: 10.1177/1753193416680133. Epub 2016 Dec 5.

Abstract

We analysed scaphoid deformity as a result of surgical treatment of scaphoid fracture nonunion and assessed the deformity associated with a dorsal intercalated segmental instability pattern of carpal malalignment. A total of 45 patients who were treated for scaphoid fracture nonunion were included in the study. The height-to-length ratio of the scaphoid was measured on computed tomographic images and used to assess scaphoid deformity. Carpal malalignment was quantified based on the radio-lunate angle. A correlation analysis between the height-to-length ratio and the radio-lunate angle was performed. Dorsal intercalated segmental instability was defined as a radio-lunate angle >15°, and a receiver operating curve analysis was used to calculate the cutoff height-to-length ratio that can be accompanied with dorsal intercalated segmental instability. Extension of the lunate increases in proportion to the flexion deformity of the scaphoid; dorsal intercalated segmental instability can occur if the height-to-length ratio of the scaphoid is >0.73.

Level of evidence: IV.

Keywords: Scaphoid malunion; carpal malalignment; dorsal intercalated segmental instability.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carpal Joints*
  • Cohort Studies
  • Female
  • Fractures, Ununited / diagnostic imaging
  • Fractures, Ununited / surgery*
  • Humans
  • Joint Instability / etiology*
  • Male
  • Middle Aged
  • Scaphoid Bone / diagnostic imaging
  • Scaphoid Bone / injuries*
  • Scaphoid Bone / surgery*
  • Tomography, X-Ray Computed
  • Young Adult