Treatment options for scaphotrapeziotrapezoid (STT) osteoarthritis are trapeziectomy with partial trapezoidal excision, STT joint fusion, and distal scaphoid excision, while the literature did not clearly indicate which treatments were better. Symptomatic patients claim pain on the radial side of the wrist and the base of the thumb, limited range of motion of the wrist and thumb, and decreased grip and pinch strength. The trapeciectomy needs additional procedures, such as the suspension arthroplasty to avoid proximal migration of the first metacarpal. The STT joint fusion may result in severe loss of thumb movement. The distal scaphoid excision induces flexion of the scaphoid that may result in flexion of the lunate showing volar intercalated segment instability deformity. Each procedure has disadvantages.
The “special review” of this issue is “Excision of the Distal Pole of the Scaphoid and the Midcarpal Joint” by Drs Izard, Parody, Glickel, Yassin, and Wollstein. They used the finite element models of types 1 and 2 lunate to analyze displacement of the trapezoid, trapezium, scaphoid, capitate, and hamate along each axis after excision of the distal pole of the scaphoid with the applied load simulating the knuckle push-up. They concluded that the midcarpal-joint structure (the types 1 and 2 lunate) affects force transfer through the wrist and may predict wrist behavior following the excision of the distal pole of the scaphoid. The type 1 lunate wrist may be more tend to mid-carpal joint collapse after excision. Further biomechanical and clinical studies should be needed to clarify these results.
Interesting wrist papers, such as the distal radioulnar joint stabilization, four-corner fusion, surgeons' expertise osteosynthesis of distal radius fractures, Aptis DRUJ prosthesis, arthroscopic wafer procedure, interesting case reports, emerging technologies, and meta-analysis on bone grafting in corrective osteotomy of distal radius malunions are also included in this issue. Don't miss it.