Abstract
Purpose
Although multiple surgical options exist for chronic static scapholunate dissociation, no single procedure has been found to be superior clinically or kinematically. We hypothesize that the reduction and association of the scaphoid and lunate (RASL procedure) is a safe and effective procedure that improves function and alleviates pain in the injured wrist. The purpose of this study is to report long-term follow-up of patients undergoing the RASL procedure over a 20-year period.
Method
Between December 1991 and September 2008, the senior author performed 36 RASL procedures for chronic static scapholunate dissociation. This reconstruction involves reduction of the rotational deformity and diastasis between the scaphoid and lunate through a dorsal approach to the wrist. Maintenance of reduction is accomplished with a cannulated, headless, smooth-shafted compression screw directed from the scaphoid to the lunate along the anatomic axis of rotation between the two bones. For the purposes of this study, patients were evaluated by visual analog pain scale (VAS), Disability of the Arm, Shoulder and Hand questionnaire (DASH), SF-36 health survey, physical examination and radiographs.
Results
Thirty-two of 36 patients were available for questionnaires and 23 available for questionnaires and physical examination, with an average time to final follow-up of 6.2 years post-operatively. The mean DASH score was 16.6, and other patient-based outcomes showed similarly favorable results. Range of motion was well preserved with 80% of the contralateral flexion-extension arc being maintained in those available for physical examination. Grip strength was well preserved at 90% of the contralateral side. X-rays showed significant decreases in scapholunate gap (p < 0.001) and scapholunate angle (p < 0.001) as compared to preoperative films. In the 32 patients followed, there were 2 treatment failures going on to have salvage procedures for progression to scapholunate advanced collapse deformities. These patients were included in the final analysis.
Conclusion
The RASL procedure is a safe and effective treatment for chronic static scapholunate dissociation. It re-aligns the scaphoid and lunate, restores function, reduces pain, and appears to be robust over time.
