Bilateral STT Arthrodesis in a Young Patient with Occult Proximal Row Coalition

Background Carpal coalitions have an incidence of 0.1 to 1% in Caucasians and up to 8 to 9% in African populations. They rarely cause clinical problems requiring investigation or treatment, but are commonly identified on imaging obtained for other indications. Case Description We report a case of a 35-year-old male with progressive degenerative change of incomplete coalitions of the scaphotrapeziotrapezoid joint (STT) in the presence of bilateral complete osseous lunate–triquetral coalitions (Minnaar type 4). He was successfully treated with staged bilateral arthrodesis with excellent symptom resolution and preservation of function. Literature Review In patients with isolated STT coalition six reports of surgery exist, two of which were for arthrodesis. This is the first described case of STT arthrodesis in a patient with coexistent lunate–triquetral coalition. Clinical Relevance The STT arthrodesis remains a safe and effective treatment for STT pain even in cases of occult carpal coalition. Functional range of movement was well preserved. Level of evidence This is a Level V study.

Scaphotrapeziotrapezoid Arthrodesis: A 10-Year Follow-up Study of Complications in 58 Wrists

Background: Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation. Methods: The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications. Results: Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; P < .0001). Opioid use within 90 days before surgery ( P = 1.00), positive smoking history ( P = 1.00), race ( P = .30), comorbidity count ( P = .25), and body mass index ( P = .19) were not associated with increased risk of reoperation. Conclusions: At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.

Scapho-Trapezio-Trapezoid Arthrodesis.

Scapho-trapezio-trapezoid (STT) arthrodesis is a relatively common procedure performed for severe STT arthritis, scapholunate instability and Kienböck's disease. Twenty-eight of 31 patients who had undergone this procedure were reviewed at a mean of 65 months following surgery (range 24 to 97 months). Four patients underwent wrist arthrodesis; two for failed STT fusion; and two for uncontrolled pain related to pre-existing carpal osteoarthritis. Ninety-two percent of patients who had a successful STT arthrodesis achieved good or excellent pain relief and 79% were satisfied with the results of surgery. Pain relief was best in patients with a pre-operative diagnosis of STT arthritis. Wrist range of motion and strength were well preserved. No patients developed isolated arthrosis in the radiocarpal, intercarpal or adjacent joints. STT provides excellent pain relief with an acceptable reduction in grip strength and range of motion. However, the benefits of this procedure must be balanced against the potentially serious postoperative complications and the possibility of arthrosis.

The Value of Scapho-Trapezio-Trapezoid Arthrodesis Combined with “De La Caffinière” Arthroplasty for the Treatment of Pan-Trapezial Osteoarthritis

13 patients, 12 female and one male (mean age 63) with pan-trapezial osteoarthritis were treated by a “de la Caffinière” arthroplasty of the first carpometacarpal joint, combined with a scapho-trapezio-trapezoid (STT) arthrodesis. 11 could be reviewed at least 3 years after surgery (average 3 years and 8 months). Non-union of the arthrodesis occured twice, once when no internal stabilization was used, once with the use of the staplizer. No impingement syndrome was recorded, and there was no correlation between the angular position of the scaphoid and mobility of the wrist. Two out of 11 “de la Caffinière” implants had to be removed. Loosening of the stem is unusual, but the cup remained only perfectly in place in two cases. There was no correlation between radiological and clinical findings and the overall result was good or excellent in 8 out of 13 (62%) of the cases. The grip and pinch strength were comparable to the results of the literature. This method cannot be further recommended because of the high rate of re-operation and the risk to the trapezium which has to be further evaluated.

Removal of Cancellous Bone Graft through the Base of the Excised Radial Styloid Process

In performing STT arthrodesis, the excision of the tip of the radial styloid avoids further radial styloid impingement. Cancellous bone graft can be obtained through the base of the excised radial styloid, using a trephine or a curette. The amount of bone removed is sufficient for intercarpal arthrodesis.