Adaptive Proximal Scaphoid Implant stability despite a perilunate dislocation: a case report
Keywords:
APSI, scaphoid non-union, perilunate dislocation, implant dislocationAbstract
Background:We present the case of a 22 y.o. male patient suffering from scaphoid non-union with avascular necrosis of the proximal pole and initial degenerative arthritis.
Case report:He referred to our institution with functional impairment and persistent pain (VAS 8\10). The patient underwent the positioning of the small size Adaptive Proximal Scaphoid Implant (APSI), without fixation, through an open dorsal approach and radial styloidectomy. The post-operative course was uneventful, and the patient could resume his daily routine without limitations. 5 years later the patient returned to our department referring a dorsal perilunate dislocation on the same hand. Unexpectedly no implant dislocation occurred and we were able to reduce the perilunate dislocation maintaining the same implant. At 30-month follow-up the patient was pain free (VAS 0\10) with almost completely recovered function of the hand and wrist.
Conclusion:In order to minimize implant dislocation, both an adequate scaphoid resection and the choice of the right implant size (which should be lightly downsized compared to the scaphoid resection) are of paramount importance. At the same time, the capsuloplasty should be carefully performed at the right tension, providing adequate stability to the implant. This technique provided satisfactory functional results in a long-term follow-up, even in a young and active patient. Moreover, it does not preclude or complicate the possibility of resorting to different surgical procedures in case of necessity, whilst maintaining the same implant.
References
2. Nacif GC, Pedro FMJ, de Moraes VY, Fernandes M, Bellot JC. How Scaphoid Fractures Are Treated in Brazil. Acta Ortop Bras. 2018;26(5):290-3.
3. Yeo JH, Kim JY. Surgical Strategy for Scaphoid Nonunion Treatment. J Hand Surg Asian Pac Vol. 2018;23(4):450-62.
4. Vender MI, Watson HK, Wiener BD, Black DM. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg Am. 1987;12(4):514-9.
5. Giacalone F, di Summa PG, Fenoglio A, Sard A, Dutto E, Ferrero M, et al. Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone: A Comparative Study to Evaluate the Role of Capitate Prosthetic Resurfacing in Advanced Carpal Collapse. Plast Reconstr Surg. 2017;140(5):962-70.
6. Kim J, Park JW, Chung J, Jeong Bae K, Gong HS, Baek GH. Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis. J Hand Surg Eur Vol. 2018;43(1):24-31.
7. Jones DB, Jr., Moran SL, Bishop AT, Shin AY. Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions. Plast Reconstr Surg. 2010;125(4):1176-84.
8. Poumellec MA, Camuzard O, Pequignot JP, Dreant N. Adaptive Proximal Scaphoid Implant: Indications and Long-Term Results. J Wrist Surg. 2019;8(4):344-50.
9. Aribert M, Bouju Y, Chaise F, Loubersac T, Gaisne E, Bellemere P. Adaptive Proximal Scaphoid Implant (APSI): 10-year outcomes in patients with SNAC wrists. Hand Surg Rehabil. 2019;38(1):34-43.
10. Gras M, Wahegaonkar AL, Mathoulin C. Treatment of Avascular Necrosis of the Proximal Pole of the Scaphoid by Arthroscopic Resection and Prosthetic Semireplacement Arthroplasty Using the Pyrocarbon Adaptive Proximal Scaphoid Implant (APSI): Long-Term Functional Outcomes. J Wrist Surg. 2012;1(2):159-64.
11. MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998;12(8):577-86.
12. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-8.
13. Taleisnik J. Classification of carpal instability. Bull Hosp Jt Dis Orthop Inst. 1984;44(2):511-31.
14. Reigstad O, Thorkildsen R, Grimsgaard C, Reigstad A, Rokkum M. Is revision bone grafting worthwhile after failed surgery for scaphoid nonunion? Minimum 8 year follow-up of 18 patients. J Hand Surg Eur Vol. 2009;34(6):772-7.
15. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am. 1985;10(5):597-605.
16. Merrell GA, Wolfe SW, Slade JF, 3rd. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am. 2002;27(4):685-91.
17. Zaidemberg C, Siebert JW, Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am. 1991;16(3):474-8.
18. Daruwalla ZJ, Davies K, Shafighian A, Gillham NR. An alternative treatment option for scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis: early results of a prospective study on the pyrocarbon adaptive proximal scaphoid implant (APSI). Ann Acad Med Singapore. 2013;42(6):278-84.
19. Pequignot JP, Lussiez B, Allieu Y. [A adaptive proximal scaphoid implant]. Chir Main. 2000;19(5):276-85.
20. Marcuzzi A, Ozben H, Russomando A. The use of a pyrocarbon capitate resurfacing implant in chronic wrist disorders. J Hand Surg Eur Vol. 2014;39(6):611-8.
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