CORRECTIVE OSTEOTOMY FOR SCAPHOID MALUNION - TECHNIQUE AND LONG-TERM FOLLOW-UP EVALUATION

Five patients with dorsal intercalated segment instability underwent c orrective osteotomy for symptomatic scaphoid malunion. Follow-up exami nation al an average of nearly 9 years after the procedure (range, 1.5 -19 years) revealed that all had improvement in range of motion (ROM). Total active ROM improved from a mean of 127 degrees (range, 95 degre es-165 degrees) to a mean of 156 degrees (range, 95 degrees-214 degree s). Grip strength increased from a mean of 16 kg (range, 14-35 kg) to a mean of 32 kg (range, 24-48 kg). The wrist score improved from an av erage of 19 to 75. The preoperative intrascaphoid and carpal malalignm ents were reduced, as demonstrated by trispiral tomography. Symptomati cally, all patients reported improvement. All osteotomies healed withi n 5.5 months of the procedure. No case of avascular necrosis was noted . Mild radioscaphoid arthrosis is apparent in four patients and a pree xisting midcarpal arthrosis persists in one patient. Corrective osteot omy for scaphoid malunion may have a role in the pre vention or stowin g of the onset of premature arthritis in young patients with high func tional demands. A technique is described.