Scaphoid Excision with Capitolunate Triquetrohamate Arthrodesis

46 Scaphoid Excision with Capitolunate Triquetrohamate Arthrodesis

Indications

Radioscaphoid and midcarpal arthritis with preservation of the radiolunate joint. This pattern is typically seen in long-standing scapholunate dissociation or scaphoid nonunion.
Some surgeons prefer scaphoid excision with capitolunate triquetrohamate (CLTH) arthrodesis to proximal row carpectomy in patients with radioscaphoid arthritis and a midcarpal joint that has no evidence of degenerative changes.

Pitfall

Elderly patients and those with severe wrist stiffness have less predictable pain relief and recovery of motion.

Technique

A dorsal, longitudinal 6 to 8 cm skin incision is made centered over the capitate (C).
Dissect to the wrist capsule between the second and fourth compartments distal to the extensor pollicis longus tendon.

Figure 46-1

Pearl

Incise the distal edge of the extensor retinaculum between the third and fourth compartments to the level of Lister’s tubercle to facilitate exposure.

Make a transverse capsulotomy across the entire dorsal wrist at the level of the capitolunate joint and reflect the capsule both proximally and distally from the carpus (Fig. 46-1).
Remove the scaphoid (S) piecemeal with a rongeur.
Excise distally projecting osteophytes from the radial styloid.