Management of chronic rotary subluxation of the scaphoid by scapho-trapezio-trapezoid arthrodesis.

The natural history of untreated rotary subluxation of the scaphoid is traumatic radiocarpal arthritis, with loss of grip strength, pain with axial loading or dorsiflexion, and decrease in the total active arc of wrist motion. Operative reduction of the proximal scaphoid pole and stabilization of the distal pole by scapho-trapezio-trapezoid arthrodesis in 12 cases showed elimination of the perpendicular scaphoid attitude, closure of scapholunate diastasis, and neither loss of reduction nor degenerative changes on follow-up for over 2 years. Postoperative cineradiographic studies showed loss of normal reciprocal motion within proximal and distal carpal rows, a marked decrease in capitoscaphoid motion, but preservation of lunocapitate motion in addition to radiocarpal motion. Nine of 12 patients without complications returned to activities performed prior to injury, without wrist pain and with 80% of preoperative motion.