Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Non-Union: Systematic Review and Meta-Analysis
Cory K Mayfield, BS; Daniel J. Gould, MD, PhD; Marie Dusch, MD; Amir Mostofi, MD
University of Southern California, Los Angeles, CA
Background: Current treatment options for the management of persistent scaphoid nonunion are limited to salvage procedure that removes the entire proximal carpal row or scaphoid excision and partial wrist fusion. Distal pole excision of the scaphoid can perhaps provide a simpler alternative with faster recovery. Small case series have shown promising results while still preserving the option of salvage procedure. The purpose of this study was to determine the efficacy of distal scaphoid excision as a treatment option for scaphoid nonunion.
Methods: The MEDLINE and PubMed databases were searched for the use of distal scaphoid excision in scaphoid nonunions. We included studies that reported on either the functional or patient-centered outcomes following distal scaphoid excision for symptomatic scaphoid non-union. We excluded those with less than 6 months of follow-up, non-English studies, those without full-text available, those that performed distal scaphoid excision for the treatment of other conditions aside from symptomatic scaphoid non-union, those that utilized any form of wrist or carpal arthrodesis in conjunction with scaphoid excision, and those that did not provide individual patient data.
Results: Six articles described the outcomes of 70 patients with an average of 11.7 patients per study. Functional outcomes were assessed using flexion-extension arc, radial-ulnar deviation and grip strength. These measures improved by an average of 98.95%, 58.96% and 131.08%, respectively. Patient-derived outcomes included the Modified Mayo Wrist Score, which improved by 92.6%, and the Distability of the Arm, Shoulder and Hand, which improved 137.17%. Complete relief of pain was found in 68.75% with 20.83% of patients experiencing pain with strenuous activity. The average postoperative Visual Analog Scale (0-10) was 0.71. 93.33% of patients were able to return to work with average time of return being 6.89 weeks. Complete satisfaction was reported by 87.80% of patients. Complications included progression into four corner fusion or PRC and newly developed midcarpal arthritis.
Conclusions: Distal scaphoid excision for scaphoid nonunions results in improvement of functional and patient derived outcomes as well as having high rates of return to work and patient satisfaction. These results are encouraging in that distal scaphoid excision may be a favorable, low-risk treatment for scaphoid nonunion without eliminating more extensive options such as four corner fusion and proximal row carpectomy.
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