Floor plan - 2013 Annual Meeting - American Association for Hand ...

Long-term Outcomes of Dorsal Intercarpal Ligament Capsulodesis for Chronic Scapholunate
Dissociation
Institution where the work was prepared: University of California, Davis, Sacramento, CA, USA
Varun Gajendran, MS1; Brett Peterson, MD1; Robert R. Slater, MD, FACS2; Robert Szabo, MD, MPH1; (1)University of
California, Davis, (2)The Permanente Medical Group
PURPOSE:
Chronic scapholunate dissociation is a common cause of symptomatic wrist instability. In an attempt to restore normal carpal mechanics
and prevent wrist arthrosis, we developed and tested biomechanically the dorsal intercarpal ligament capsulodesis (DILC). Previously,
we reported good early clinical results for this procedure. Here, we report on the functional and radiographic outcomes of these
patients at long-term follow-up.
METHODS:
After IRB approval, records of patients undergoing the DILC for chronic (greater than 6 weeks), flexible, static scapholunate dissociation
were reviewed. Only patients with follow-ups of greater than 60 months were included. Physical examination, radiographs, and validated
outcome instruments were used to evaluate the patients.
RESULTS:
Twenty-one patients (22 wrists) met the inclusion criteria. Fifteen of these 21 patients (16 wrists) were available for follow-up. After an average
follow-up period of 86 months, physical examination revealed an average wrist flexion and extension of 50Ña and 55Ña respectively,
radial and ulnar deviation of 17Ña and 36Ña respectively, and grip strength of 61 kgf. DASH, SF-12, and Mayo wrist scores averaged
19, 78, and 78 respectively. Radiographs revealed an average scapholunate angle and gap of 62Ña and 3.5 mm respectively. Eight of the
16 wrists in our study demonstrated arthritic changes on radiograph, including one patient who developed Stage IV arthritis of the wrist.
CONCLUSION:
Our results show that the DILC does not prevent radiographic deterioration and the development of arthrosis in the long term.
However, the level of functionality and patient satisfaction remained high in the majority of our patients, suggesting a lack of correlation
between the radiographic findings and development of arthritis on one hand and functional outcomes and patient satisfaction on
the other hand. Based on these findings, we believe that the DILC is still a good choice for treating flexible static scapholunate dissociation
in carefully selected patients. Prevention of radiographic deterioration and arthrosis, however, remains an unsolved problem.
Treatment of Scaphoid Fractures and Nonunions with a Cannulated AO Screw and Threaded
Washer: Report of 99 Cases
Institution where the work was prepared: University of California San Diego, San Diego, CA, USA
Andrew Pennock, MD1; Todd Horton, MD2; William Tontz, MD1; Reid Abrams, MD3; (1)University of California San
Diego, (2)Naval Medical Center, (3)University of California, San Diego
PURPOSE:
Several implant designs have been utilized for the rigid internal fixation of scaphoid fractures. To date, no study in the literature has
reported surgical outcomes using the 3.0 mm cannulated AO screw lagged through a threaded washer. The purpose of this study was
to evaluate union rates in a consecutive series of patients who had internal fixation of a scaphoid fracture or nonunion using this device.
WITHDRAW
METHODS:
From September 1996 to September 2006, 68 consecutive scaphoid waist fractures requiring surgical stabilization were treated with a
3.0 mm cannulated AO screw and threaded washer by a single surgeon. Nondisplaced fractures were treated through a mini-volar
approach while displaced fractures and nonunions were treated with an open volar approach. At the time of surgery, if nonunions were
unstable, bone graft from the iliac crest or distal radius was harvested, but if stable, graft was not utilized. Charts and radiographs were
reviewed from all patients and pertinent demographic and clinical data were recorded. Postoperative radiographs were reviewed to
assess fracture union and screw position.
RESULTS:
The union rate for the 21 nondisplaced fractures was 100% with an average time to union of 15.5 weeks. The union rate for the 23 displaced
fractures was 96% with an average time to union of 17.1 weeks. In none of the acute fractures was it necessary to remove symptomatic
hardware. The union rate for the 24 nonunions was 92% with an average time to union of 22 weeks. In two instances, symptomatic
hardware had to be removed which had migrated into the scapho-trapezio-scaphoid joint.
CONCLUSION:
The 3.0 mm AO cannulated screw and threaded washer can be used reliably and safely to treat both scaphoid waist fractures and
nonunions. A theoretic advantage of this device is that it enables the controlled compression of the scaphoid if resorption occurs across
the fracture site, increasing the probability of successful union. This benefit is not without risk of distal screw migration, which was
observed in two cases in this study. We therefore recommend close radiographic follow-up in all cases until bony union is achieved.
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