الفهرس 
PRINCIPLES OF LIMITED WRIST FUSIONOnly 14 pages are availabe for public view
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Abstract
- As the treatment of scaphoid nonunion advanced collapse GII and III were debatable, we have tried in this study to compare between two different techniques using the same fixation method to assess any differences between them as regard operative time and functional outcomes.
- We performed a prospective randomized control study on 34 patients with scaphoid nonunion advanced collapse GII and III. Randomization was done using Microsoft Excel. group (A) including 17 patients where three corner fusion without triquetrum excision was done, and group (B) including 17 patients where the conventional four corner fusion was done. All patients were operated using dorsal approach with ligament sparing, using k-wires as fixation method after correction of any DISI deformity and preparation of articular surfaced as needed. Postoperative patient assessment was done according to the VAS score, Modified Wrightington Hospital wrist scoring system (MWHWS) and Mayo modified wrist score (MMWS).
- As regard operative outcomes, the mean operative time in minutes, in group (A) was 77.65 , versus 103.82 in group (B) , which was statistically significant. Furthermore, more than half of cases in group (B) , further graft were needed.
- As regard functional outcomes, in group (A) the mean VAS was 2.88 , mean MWHW was 70.88 and mean MMW was 70.59. Those results were comparable to group (B) with no statistically significant difference.
- According to this work, we conclude that good comparable functional results can be obtained when we compared three corner fusion without triquetrum excision to the conventional four corner fusion, with a shorter operative time without the need to use further graft rather than the excised scaphoid. Also, we concluded that preservation of the triquetrum during limited wrist fusion has no significant impact on postoperative ulnar deviation range and Correction of the extension deformity of the lunate and the relationship between the capitate and lunate is an important factor to achieve union.
- Further comparative studies needed with longer follow up to assess the long-term outcomes, the rate of development of arthritis and conversion to total wrist arthrodesis.