Bicolumnar Fusion as a Reliable Technique for Scaphoid Non-Union Advanced Collapse | ||
| The Medical Journal of Cairo University | ||
| Volume 93, Issue 09, September 2025, Pages 1289-1296 PDF (108.55 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/mjcu.2025.464442 | ||
| Author | ||
| AYMAN M. MANSOUR, M.D.*; MOSTAFA M.A. HASSANIN, M.D.*; ASHRAF N. MOHARRAM, M.D.* MOHAMED I. GABR, M.Sc.** | ||
| The Department of Orthopedic Surgery, Faculty of Medicine, Cairo University* and Helwan University Hospital** | ||
| Abstract | ||
| Background: Scaphoid nonunion advanced collapse is a degenerative process, which follows scaphoid fracture non-union or Malunion resulting in predictable pattern of wrist arthritis. Various types of intercarpal arthrodesis have been described. Bicolumnar fusion offers arthrodesis of the lu-nate-capitate and triquetrum-hamate joints, but sparing of the lunate-triquetrum and capitatehamate joints. The use of cannu-lated headless screws allows adequate compression of prop-erly adapted joint to unite not to use bone graft, with shorter operative time and good result compared to other methods of midcarpal fusion. Aim of Study: Accessing clinical results of bicolumnar fu-sion compared to previous methods of treatment for scaphoid non-union advanced collapse (SNAC). Patients and Methods: The study was conducted on thir-ty patients, with SNAC presenting to the outpatient clinic of Kasr Al-Aini hospital and El Helal hospital from June 2013 to June 2016. All patients underwent bicolumnar wrist fusion. Patients were assessed preoperatively by clinical examination, Radiographic Plain X-rays, CT scan & routine preoperative laboratory investigations. Functional outcome measured using quick disability of arm, shoulder and hand score (QDASH), modified mayo wrist score (MMWS) and visual analogue scale score (VAS). Results: The study was conducted on thirty patients, with SNAC, 29 males and one female. The mean age was 32.33 years. 17 patients were affected on dominant hand while 13 on non-dominant hand. Only seven patients (23.3%) had history of previous surgery, nine were immobilized and seventeen did not seek medical advice. In wrist range of movement, signifi-cant difference in the mean wrist flexion range decreasing from 56° to 37° (p-value=.000). Wrist extension, show significant difference in the mean range decreasing from 53.17° to 44.38° (p-value=.004), also radial deviation decreased from 12.67° to 9.83°. On the contrary, results showed significant increase in the mean ulnar deviation from 16.83° to 21.17° (p-value=.013) and the mean grip strength from 22.13 kg to 33.53 kg (p-value =.000). In wrist measurement, significant difference noted in all scores, MMWS (p-value=.000), QDASH (p-value=.000), and the pain on VAS (p-value=.000). Conclusion: Bicolumnar fusion is a reliable, simple treat-ment for SNAC resulting in good range of movement and bet-ter grip strength, no bone graft and low complication rate. | ||
| Keywords | ||
| Bicolumnar fusion; SNAC; Wrist arthritis | ||
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