Arthroscopic Scaphocapitate Fusion: Surgical Technique

ABSTRACT: Scapholunate fusion appears to be an interesting surgical solution for carpal pathologies, which are sometimes difficult to manage as Kienbock’s disease or chronic scapholunate instability. Open intracarpal fusion is notorious for decreasing joint range of motion due to the fusion of several carpal bones and because of the capsulotomy sectioning important ligamentous elements in carpal biomechanics. Wrist arthroscopy has already demonstrated its effectiveness in preserving joint mobility compared with open procedures. In this work, we present a detailed procedure for performing a scaphocapitate fusion under arthroscopy by specifying the key points of this procedure in our experience. Technique Video Video 1 Arthroscopic scaphocapitate fusion. Patient in supine position. Tourniquet inflated to 250 mmHg. The traction is applied by a Finochietto hand or by finger traps. A classic arthroscopic midcarpal exploration and debridement are performed by using ulnar and radial midcarpal portals. Lesions of the scapholunar capsuloligamentous complex will not be repaired. A detailed arthroscopic exploration must be carried out to ensure the right indication of the fusion. In this case, isolated scaphocapitate arthrosis was found in the context of chronic scapholunate instability. An extended synovectomy over the entire midcarpal surface of the scaphoid will allow better visualization of the scaphocapitate joint, which is narrow, and better instrumentation. An initial vigorous bone debridement is performed with a curette and a 2.9-mm burr at the level of the articular surfaces until the remains of cartilage are removed to expose the subchondral bone. The bone graft is taken from the distal radius according to conventional rules. The bone graft is fragmented to be then introduced into the radiocarpal level under arthroscopic control using a 20 gauge needle trocar caps that are beveled then filled manually and introduced by the 3-4 and 6R portals alternately. Internal fixation must be rigid to ensure complete fusion and always takes place without traction. We use self-tapping, double-pitch cannulated screws 1.8 mm in diameter, Herbert type. The introduction is percutaneous from the scaphoid to the capitate with a perpendicular axis to the articular surface. A minimum number of two pins is required. However, depending on the indications, a third screw can be added on the axis of the scaphoid. Depending on the remaining space, an additional screw can be inserted from the capitate to the radius to increase the compression effect.

SUBMITTER: de Villeneuve Bargemon J 

PROVIDER: S-EPMC9353331 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature