Clinical Example: Midcarpal instability following distal scaphoid excision

Distal scaphoid excision is gaining popularity as a treatment of scaphoid nonunion. It requires the strong radioscaphoid and radioscapholunate ligaments to maintain support of the remaining proximal carpus. In this case, the proximal carpus was destabilized by the effect of radial stylidectomy on these ligaments.

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Clinically and by bone scan, this patient sustained a scaphoid fracture, but obviously had a preexisting distal pole cyst.
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Intraoperatively, the distal pole cyst was eggshell thin with comminution into the ST joint. Stable fixation was not possible, even with a radial
styloid bone graft, and the distal pole was excised. Postoperatively, carpal instability was present.
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This progressed...
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Carpal tunnel developed and progressively worsened, probably related to the palmar prominence of the lunate. The patient underwent carpal
tunnel release and midcarpal fusion and returned to heavy manual work.
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