The authors investigated the changes in wrist motion resulting from radioscapholunate arthrodesis and the effects of surgical techniques to improve range of motion in 6 cadaveric limbs. Radioscapholunate arthrodesis diminished the amplitudes of movements of the wrist in all directions when compared to unfused wrists (49% of flexion/extension and 76% of radial/ulnar deviation). Wrist motion was partly restored in the radioscapholunate fused wrists after distal scaphoidectomy (75% of flexion/extension and 83% of radial/ulnar deviation). Additional improvements in wrist motion were measured after combining distal scaphoidectomy with triquetrectomy (88% of flexion/extension and 98% of radial/ulnar deviation).
Radioscapholunate arthrodesis is a recognized salvage procedure for wrists with radiocarpal osteoarthritis involving the lunate facet. However, wrist motion is restricted and patients are prone to develop midcarpal degenerative arthritis (Hand Clin 2005). Garcia-Elias et al. (JHS Am 2005) applied distal scaphoidectomy with radioscapholunate fusion in 16 patients and found good results at an average follow-up of 3 years. The addition of a triquetrectomy may lead to a further improvement in wrist motion and conceivably mitigate the adverse effects on triquetrohamate kinematics from radioscapholunate arthrodesis.