Scaphoidectomy and Midcarpal Tenodesis is a Valid Alternative to Midcarpal Arthrodesis and Proximal Row Carpectomy for SLAC and SNAC Stage II

The aim of this study is to report the early and midterm results of a new technique in which the scaphoidectomy is associated with midcarpal tenodesis (MCT), used to stabilize the luno-triquetral carpal bones, preventing carpal collapse in scapholunate advanced collapse (SLAC) stage II and scaphoid nonunion advanced collapse (SNAC) stage II. A total of 27 patients with a mean age of 35 years were operated on with this technique after diagnostic arthroscopy. Patients with normal cartilage of the luno-capitate (LC) and radio-lunate (RL) joints underwent scaphoidectomy and MCT. Preoperatively and postoperatively, all patients were evaluated by radiological and clinical examination according to the Mayo Wrist Score (MWS). Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaires were also used. Only 3 of 27 cases failed and were treated by proximal row carpectomy (PRC) and MCT. Ten cases out of 27 patients had preoperative and postoperative complete data suitable for statistical analysis. At a follow-up of 2 years, the mean pain at stress and at rest decreased significantly. Mean MWS increased, and it was statistically significant (p = 0.03). DASH and PRWHE scores decreased, and both reached a statistical significance of 0.002 and 0.014, respectively. Radiographic imaging showed a radial translocation of the capitate in four cases, ulnar translocation of the luno-triquetral bones in two cases, dorsal intercalated segmental instability (DISI) deformity in eight cases, and midcarpal arthritis in nine cases. At a mean follow-up of 7 years, all the patients were still satisfied without worsening of the clinical parameters. Radiographic imaging showed a reduction of carpal height in one case, progression of the ulnar translocation and DISI deformity in two cases, and radiographic midcarpal arthritis in all cases, but no one complained of discomfort at the wrist motion and during work activity. The technique demonstrated to have a place between the PRC and the MCA, and it should be used when the RL and LC joints are still normal without breaking the bridge with these two previous surgical possibilities.