Resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed previous surgical treatment.

PURPOSE

To evaluate the results of resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed prior surgical treatment.

METHODS

Thirteen patients who were treated with resection of the scaphoid distal pole for persistent nonunion after previous surgical treatment were included in this study. The mean follow-up period was 5 years. Evaluation included measurement of wrist range of motion, assessment of pain, and evaluation of radiographic parameters. The Disabilities of the Arm, Shoulder, and Hand score was used to determine the functional outcome after the excision.

RESULTS

Before surgery all but 1 patient reported pain. After surgery 2 patients presented with mild pain during strenuous activity. Mean wrist flexion and extension increased significantly, by 23 degrees and 29 degrees, respectively. The postoperative Disabilities of the Arm, Shoulder, and Hand score was 25 +/- 19 points. There was a significant increase in the radiolunate angle, indicating dorsal intercalated segment instability deformity in 6 patients.

CONCLUSIONS

Scaphoid distal pole excision remains a valuable treatment option for patients for whom multiple attempts at union have failed previously and who have no associated complete scapholunate ligament tears.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.