[Partial midcarpal arthrodesis with excision of the scaphoid for the treatment of advanced carpal collapse].

Objective: To eliminate painful arthrosis between the radius and scaphoid and between the lunate and capitate. Stabilization of the carpus with preservation of useful range of motion between the radius and the lunate.

Indications: Painful arthrosis of radioscaphoid joint due to an old lesion of the scapholunate ligament or a long-standing scaphoid pseudarthrosis with loss of carpal height (advanced carpal collapse, stage II) and eventual additional midcarpal arthrosis (stage III).

Contraindications: More complex Damage of carpal ligaments. Arthrosis of radiolunate joint. Ulnar displacement of the lunate. Rheumatoid arthritis. Calcium pyrophosphate deposition disease (relative).

Surgical Technique: Dorsal approach. Excision of scaphoid. Removal of articular cartilage between capitate and lunate and between hamate and triquetrum. Repositioning of capitate in relation to the lunate. Osteosynthesis with several Kirschner wires.

Postoperative Management: Immobilization in a plaster cast for 8 weeks; then, early removal of the wires.

Results: From 1993 to 2001, 64 partial midcarpal arthrodeses with excision of the scaphoid were performed in 62 patients. 26 of the patients operated up to 1999 were followed up for 27 months and evaluated with the Cooney Score and the DASH Score. The Cooney Score significantly improved, from 46 points preoperatively to 76 points postoperatively. Postoperative DASH Score was 22. Postoperative range of motion, 64 degrees extension/flexion, had hardly changed compared with the preoperative value. Strength increased from 24 to 34 kg on average. Out of the 55 patients available for follow-up (29 interviewed by telephone) 35 were completely satisfied, 13 satisfied with reservations, and seven dissatisfied. 24 patients had no activity-related pain. Different degrees of activity related pain were reported by 28 patients, and pain during minor activities or at rest was reported by three patients.