OTA 2012 Posters

Scientific Poster #103 Upper Extremity OTA-2012

Treatment of Acute Versus Chronic Proximal Row Carpal Injuries

Eric R. Wagner, MD1; Robert R. Gray, MD2; Sanjeev Kakar, MD1;
1Mayo Clinic, Rochester, Minnesota, USA;
2University of Miami Health Systems, Miami, Florida, USA

Purpose: Currently, there is limited information regarding the clinical outcomes following percutaneous pinning of proximal carpal row injuries. The purpose of this study was to compare percutaneous pinning and capsulodesis of predynamic or dynamic proximal carpal instability versus pinning alone.

Methods: A retrospective chart review from was conducted of all patients with carpal instability from 1998 to 2008. Patients with predynamic or dynamic scapholunate or lunotriquetral ligament injury treated with percutaneous pinning alone or in conjunction with primary repair or dorsal capsulodesis were identified. We excluded all patients who had sustained perilunate lesser arc or greater arc injuries. Pre-and postoperative radiographs were evaluated for scapholunate diastasis, radioscaphoid, and scapholunate angles. Pre- and postoperative Mayo wrist scores (MWS) and visual analog scale (VAS) scores were obtained.

Results: 61 patients with predynamic and dynamic injuries were identified with an average follow-up of 22.3 months. Postoperative immobilization averaged 6.6 weeks. The VAS scores decreased from 5.3 (±1.6) preoperatively to 2.1 (±2.0) after surgery with a mean difference of 3.1 (P <0.001). The mean MWS improved from 63.2 (±16) preoperatively to 72.0 (±16) after surgery at the last follow up appointment, with an average improvement of 6.1 points (P <0.01). Postoperative MWS improved when the procedures with concomitant open reduction and internal fixation (ORIF) of distal radius fracture (P <0.01). No other variable demonstrated significant improvements in postoperative MWS. Factors associated with improved pre- to postoperative MWS include acute injuries (P <0.01), male gender (P <0.02), concomitant distal radius ORIF (P <0.01), no active workers’ compensation claims (P <0.05), and no previous surgeries (P <0.04). Although there was a significant improvement when comparing preoperative to postoperative VAS scores among most variables, among only postoperative VAS scores, male gender (P <0.05) and the presence of a concomitant distal radius ORIF (P <0.01) led to an improved comparative postoperative pain level. No other variable had a significant effect on postoperative pain level. The average pre- and postoperative scapholunate intervals measured 1.9 mm and 2.1 mm for all patients (P >0.80). The average pre- and postoperative scapholunate angles were 58.6° and 62.5°, respectively (P >0.80).

Conclusions: These results suggest that percutaneous pinning of predynamic and dynamic proximal carpal row injuries does not significantly improve clinical outcomes, except in the case of concomitant distal radius fracture. Other factors that improve results include no workers’ compensation claims, male gender, first-time operation, and possibly acute injuries. Open repair or capsulodesis did not seem to improve the outcomes.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.