Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrist.

BACKGROUND: Four-corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure.

METHODS: We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow-up period was 44.5 months (range, 22-68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion-extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded.

RESULTS: Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion-extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies.

CONCLUSION: Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain-free wrist. Moreover, these results were maintained at follow-up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four-corner fusion for advanced degenerative osteoarthritis of wrists.