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63 cpnCK~ APX~B 3A UEnOKynHO nEKAPCTBO BIBLlD: 0370-8179,129(2001) 3-4 p.

64 UDC:616.727.4-008.036 INCIDENCE AND SEVERITY OF DEGENERATIVE CHANGES IN THE WRIST WITH NONUNION OF THE SCAPHOID BONE D. MIRITSH, CH. VUCHETITSH, K. SENOHRADSKI, LJ. MITSHUNOVITSH Institute of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade INTRODUCTION In patients with symptomatic scaphoid nonunion there was an increased evidence of progressive osteoarthrosis expressed as instability of the wrist [1, 2];

it is defined as a scapholunate angle of more than

70 degrees or a radi- olunate angle of more than

10 degrees. Intercarpal instability causes unnatural joint movement of the wrist. This disorganization of the wrist mechanism as- sociated with hypermobility of the schapoid bone induces degenerative changes [3]. Arthritic changes begin at the distal scaphoid-radial sty- loid joint and later progress to the capitolunate joint. A similarity was noted with rotatory instability of the scaphoid bone associated without fracture [2]. If mid-carpal joint exists the joint becames unstable, the lunate rotates backwards and carpal bones show the so- called concertina deformity [4] or dorsal intercalated seg- ment instability pattern [5]. AIM We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. METHOD In this study

40 patients with painful nonunion of the scaphoid bone were analysed. Duration of nonunion was 1.43 year (range from

8 months to

15 years). Roentgenograms of the hand were done in anteroposte- rior, lateral and oblique projections. Fracture location and configuration were determined as described by Russe. Instability was determined by measuring the scapholu- nate and radiolunate.angle in the lateral roentgenogram. Scapholunate angle more than

70 degrees and radiolu- nate angle more than

10 degrees were considered ab- normal. To asses the amount of carpal collapse the carpal index was determined as described by Youm [6]. Abnormal value was 0.50 or less (normal value: 0.54 ± 0.03). Four roentgenographic groups were established based on the extent of degenerative changes [7]. Group I showed no sign of degenerative changes. Group II had sclerotic lesions in fracture margins with or without a cys- tic formation. Group III showed lesions of radioscaphoid arthritis, including joint-space narrowing and pointig the radial styloid. Group IV had lesions of generalized arthri- tis of the wrist. RESULTS Duration of nonunion was not in correlation with develop- ment of osteoarthritic changes (p = 0.644, P >