Comparison of the effects of preferred dorsal and volar surgical approaches on wrist kinematics in scaphoid pseudarthrosis

Comparison of the Effects of Preferred Dorsal and Volar Surgical Approaches on Wrist Kinematics in Scaphoid Pseudarthrosis Objective: Our study aimed to compare the clinical results of pseudoarthrosis surgeries performed with volar and dorsal approaches in the treatment of scaphoid pseudoarthroses and their effects on wrist functional kinematics. Patients and Methods: The study was planned as a prospective comparison of matched groups after obtaining ethical committee approval. Between January 2020 and December 2021, patients who were diagnosed with wrist scaphoid pseudoarthrosis in Istanbul University, Istanbul Faculty of Medicine, Orthopedics and Traumatology clinic were divided into two groups according to the surgical approach: Dorsal group and volar group. In our functional evaluation, preoperative and postoperative Visual analog scale (VAS), patient rated wrist evaluation 'PRWE' questionnaire and MAYO wrist score, range of motion measurements with a manual goniometer, scapolunate angle on radiography, wrist grip strength and pinch strength measurements were used. Motion analysis system based on Inertial Measurement Unit 'IMU' that Collects Angular and Linear Acceleration Data in Bahçeşehir University Biomedical Engineering Laboratory at the preoperative and postoperative 10th month for all patients, Xsens Data were analyzed by performing predetermined tasks (telephone calls, drinking from a glass, touching the perineum, putting a wallet in the back pocket) with the Awinda system ™ ( Xsens Technologies, BV, Enschede , Netherlands ). Results: We achieved union in 11 of 12 patients who underwent volar surgery and in 10 of 11 patients who underwent dorsal surgery. The mean age of the patients was 24.3 in the volar group and 22.4 in the dorsal group. In both groups, 4 dominant and 5 non-dominant sides were operated. Wrist grip strength, pinch strength and functional scores increased significantly in both volar and dorsal surgery groups compared to preoperatively (p=0.008). However, no significant difference was observed between the groups (p=0.85). In patients who underwent both volar and dorsal surgery, the range of motion measured by goniometer increased in both groups, but it was not significant compared to the preoperative values. In the volar group, mean flexion is from 55° +- 9° to 60°+- 5° (p=0.1), extension is from 47°+-10° to 48.7°+-5°, radial deviation is from 9°+- 3° to 13.3 °+-4°, ulnar deviation increased from 18.2°+-° to 20.1°+-5°, but these increases were not statistically significant (p=0.8). Similarly in the dorsal group, flexion 55°+-9° to 61°+-5°, extension 48°+- 6° to 53.4°+-7°, ulnar deviation 17.2°+- 6° to 19.2 °+- 4°, radial deviation increased from 14.3°+- 5° to 16.3°+- 5°, but these changes were not statistically significant (p=0.7). xiii In the pre- and post-union movement analysis of our patients, it was found that the maximum extension of the dorsal group approached to the task in the telephone interview (19.7°+-7° after the operation, 21.1°+-3° , p=0.8), and the radial ulnar deviation gap was significantly reduced (Operational). after 17.8°+-6° Robust 24.3°+-9° , p=0.03). In the volar group, however, the maximum extension was found to be significantly less than the healthy side (26.2°+-4° after the operation, Healthy 37.8°+-8° p=00). In the task of drinking water from a glass, the degree of pronation increased, especially in the volar group, and resembled the healthy side (17.3°+-4° intact 19°+-5° after the operation, p=0.31). In the task of touching the perineum, it was observed that the flexion-extension range of motion and maximum flexion values of the dorsal group decreased compared to the preoperative values and were significantly behind the healthy side (36.8°+-10° after the operation, 49°+-9 p=0.02). In volar surgery, these values were increased but still significantly less on the healthy side (38.5°+-11° preoperative 30+-17 post-operative, healthy 54°+-15° p=0.01). In the movement of putting a wallet in the back pocket, which was mostly done with supination extension, the radial-ulnar deviation decreased and significantly decreased in the volar group compared to the healthy side (16.8°+-4° after the operation, 23°+-3° p=0.007), on the other hand, there was a decrease in the maximum supination. however, it was observed that the pronation-supination motion arc increased significantly (from 12.9°+-3° before the operation to 17.2°+-6° P=0.08). In the dorsal group, the radial ulnar deviation arc was significantly reduced compared to the intact side (invisible 30.1°+-6° Post-operative 21°+-6° p=0.04). The pronation-supination arc increased but was not significant compared to preoperatively (preoperative 16°+-4° to 20°+-6° p=0.1). Unlike the volar, it was found that the flexion-extension range of motion increased and became similar to that of the healthy side (33.2°+-10 Robust 29.6°+-8 Postoperative p=0.3). In the volar group, this situation was reversed, and the flexion-extension arc of motion was significantly reduced compared to the intact side (22°+-4° after the healthy 31°+-6° operation). Conclusion : Surgeries performed with both approaches are successful treatment methods with appropriate patient selection. Although they have similar goniometric measurement values and functional evaluations, real differences emerge during tasks due to the multiaxial nature of wrist movement. In tasks requiring flexion, radial deviation and pronation, better data were obtained in the volar group. İn tasks requiring extension better data were obtained in the dorsal group. This functional analysis that we have done can be effective in choosing the treatment according to the characteristics and expectations of the patients. It can also guide us in terms of post-operative physical therapy protocol.