The Effect of Distal Scaphoid Excision and Triquetrum Excision on Radioscapholunate Fusion: A Systematic Review.

Abstract

Radioscapholunate (RSL) fusion is a motion-preserving limited wrist fusion treatment option for symptomatic radiocarpal arthritis; however, there is no consensus regarding the need for excision of the distal scaphoid or triquetrum. This study aimed to determine the impact of distal scaphoid excision (DSE) and triquetrum excision (TE) in RSL fusion and compare the outcomes and complications. A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and relevant clinical studies on RSL fusion were retrieved from Scopus, MEDLINE, and Embase. Meta-analysis with a random-effects model was used to assess the functional and clinical outcomes, including range of motion; grip strength; Disabilities of Arm, Shoulder, and Hand scores; visual analog scale pain scores; and Patient-Rated Wrist Evaluation scores. The rates of complications were analyzed. The analysis included a total of 24 studies involving 477 wrists, of which, 49% had RSL fusion alone, 41% had RSL fusion with DSE, and 10% had RSL fusion with DSE and TE. Meta-analysis demonstrated improved postoperative flexion and radial deviation in wrists with DSE compared to those without, by 8° and 3°, respectively. The incidence of nonunion was significantly lower in wrists with DSE and wrists with DSE and TE. The incidence of secondary midcarpal osteoarthritis was the lowest in wrists with DSE, but highest in wrists with DSE and TE. Excision of the distal scaphoid resulted in slightly increased ranges of wrist flexion and radial deviation and reduced the rates of nonunion and secondary midcarpal osteoarthritis in RSL fusion. Patients who have had combined DSE and TE, demonstrated an increased incidence of secondary midcarpal degeneration. Therapeutic IV.