Volar Radioscapholunate Arthrodesis and Distal Scaphoidectomy After Malunited Distal Radius Fractures

J Hand Surg Am. 2017 Sep;42(9):754.e1-754.e8. doi: 10.1016/j.jhsa.2017.05.031. Epub 2017 Jul 1.


Purpose: The purpose of this study was to assess range of motion (ROM), pain, and incidence of radiographic degenerative joint disease (DJD) after volar radioscapholunate (RSL) arthrodesis and distal scaphoidectomy (DSE) following malunited distal radius fractures (DRF).

Methods: Fourteen patients with malunited DRF and DJD limited to the radiocarpal joint underwent RSL arthrodesis and DSE between 2006 and 2014. These were retrospectively analyzed both clinically and radiologically. Eleven patients with a mean follow-up of 63 months (range, 30-97 months) were included in the final analysis because 1 was unavailable and 2 had died. The outcome was evaluated using parameters of pain, ROM, grip strength, nonunion rate, and DJD of the adjacent joints. In addition, self-assessment by patients was registered on the Disability of the Arm, Shoulder and Hand score, Patient-Rated Wrist Evaluation score, and Michigan Hand Outcomes Questionnaire. To investigate DJD and union, a computed tomography (CT) scan at the final follow-up visit was performed.

Results: All patients showed union and no midcarpal DJD in the CT scans at final follow-up. The mean ROM in extension was 53°, flexion 42°, supination 81°, pronation 85°, radial deviation 10° and ulnar deviation 25°. The ROM in extension, extension/flexion arc, and supination improved significantly after surgery. Patients achieved a mean of 80% of grip strength compared with the other hand.

Conclusions: Volar angular stable plate RSL arthrodesis with resection of the distal scaphoid pole is a safe and effective method for treating malunited DRF. This leads to an improved ROM and low pain level.

Type of study/level of evidence: Therapeutic IV.

Keywords: Distal radius fracture; malunion; partial wrist fusion; radioscapholunate arthrodesis; scaphoidectomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthrodesis / methods*
  • Bone Plates*
  • Female
  • Fracture Fixation, Internal / methods*
  • Fractures, Malunited / diagnostic imaging
  • Fractures, Malunited / surgery*
  • Hand Strength
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Range of Motion, Articular
  • Retrospective Studies
  • Scaphoid Bone / surgery
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / physiopathology
  • Wrist Joint / surgery*