Radial Styloid Wedge Osteotomy for Early SLAC Wrist, Nonunion of the Scaphoid and for Painful Radial Styloid Impingement Syndrome: A Preliminary Report

Abstract

Painful arthritis around the radial styloid is induced in scapholunate advanced collapse of the wrist (SLAC). This change also occurs in non-union of the scaphoid and in triscaphe arthrodesis.

We devised a closing wedge osteotomy of the radial styloid as a treatment for this problem. We removed a radially based wedge of bone with an angle of 8° from the subchondral bone of the inter-articular ridge separating the lunate and scaphoid fossae. The articular surface of the inter-articular ridge was kept intact. The defect was closed and fixed by using staples. A short arm cast was applied for 4 weeks.

We performed these procedures in 5 wrists of four patients (2 females and 2 males). The patients’ ages ranged from 47 to 55 years (average 51.5 years). This series included two cases of scapholunate advanced collapse, two with both radial styloid impingement and ulnar abutment syndrome, and one with aseptic necrosis of the scaphoid bone (Preiser’s disease).

The radioscaphoid space was opened immediately after surgery suggesting decompression in that joint. All patients regained a pain-free wrist, with the follow-up period ranging from 6 to 30 months except for the most recent case. The space in the radioscaphoid remained open after the operation in each patient. All the patients were relieved from pain, tenderness, and swelling in the radiocarpal joint shortly after surgery and soon returned to their original jobs. There has been no sign of progressing arthritis or collapse of carpal bones noted thus far. The preoperative

range of the operated wrist was maintained postoperatively.

Intraoperative measurement of contact pressure of the radiocarpal joint was carried out in one of the patients. Manual compression or simultaneous contraction of flexor and extensor tendons using electric stimulation clearly demonstrated shifting of the contact pressure from the radial to the ulnar side. Similar results were obtained regardless of the wrist position.

Closing wedge osteotomy of the radial styloid effectively unloads contact pressure at the radial side of the radiocarpal joint without inducing instability or contracture of the wrist joint. This new operative procedure may be a useful treatment for SLAC wrist, especially in the early stage.