Purpose: The author first presented our paper entitled, “Radiolunate Fusion with Excision of the Scaphoid and Triquetrum for Radiocarpal arthrosis following malunion of intraarticular fracture of the radius” in 1997 at the Denver ASSH annual meeting. This is to provide an update on the technique.

Materials and Method: The original paper included nine patients who underwent the surgery. Indication for all patients was a painful wrist after malunion of intraarticular fracture of the distal radius. One had radioscapholunate fusion done without success. All were men with mean age of 38 (range 26-44 years), and none was working prior to the surgery. The dominant side was involved in 7 patients and the nondominant side in 2. All but 2 were worker’s compensation cases. The mean time from the initial fracture to the procedure was 13.3 months (range 5-36 months). Various fixation techniques, including a Herbert screw with or without K-wires, a blade plate, and bone staples were used. Postoperative immobilization with short arm cast was used for 3 to 4 weeks. The same procedures were done in twelve more patients since.

Results: Fusion between the radius and lunate was achieved in all cases. All stated that their wrist was much better than before the operation. The mean ranges of motion were 60 degrees of flexion-extension and 35 degrees of radioulnar deviation. One subluxation of the lunocapitate joint occurred requiring wrist fusion. This was due to a technical error, which will be discussed at the presentation.

Discussion: Radioscapholunate (RSL) fusion can eliminate the arthritic joints but usually results in limited and painful motion. This is due to the altered kinematics of the midcarpal joint. Excision of the scaphoid and triquetrum gives freedom of motion for capitate on lunate, instead of limiting it as in RSL fusion. Proximal row carpectomy (PRC) is a well accepted salvage procedure for the wrist, while it cannot be successful in patients with damaged lunate fossa of the radius. Radiolunate fusion with excision of the scaphoid and triquetrum (RL-S&T) mimics PRC, while the motion is maintained at the normal lunocapitate joint instead of on the damaged lunate fossa. It also overcomes one of the pitfalls of PRC that is relative lengthening of the tendons across the wrist, as it maintains the near normal carpal height. We believe RL-S&T is a superior, motion salvaging solution for the troublesome radiocarpal arthrosis following intraarticular fracture of the distal radius.