David J. Slutsky


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3475 Torrance Blvd., Ste F
Torrance, CA 90503


Appointments: 310.792.1809
Fax: 310.792.1811

Office hours: M-F, 9am – 5 pm

Worker’s compensation, Medicare and most insurance plans accepted.

In September 2008, we will be moving to a beautiful new 4,400 sq ft, state of the art dedicated hand center located at 2808 Columbia Ave in Torrance, CA., which will feature onsite nerve conduction studies, occupational hand therapy and digital x-ray.
 


PROCEDURES

RADIAL STYLOIDECTOMY

Indications
Radial styloidectomy is an early salvage procedure that may provide short term relief of mechanical pain from radial styloid impingement. This is a form of wrist osteoarthritis that can arise due to a longstanding scaphoid nonunion or due to a chronic scapholunate ligament tear (link to styloidectomy 1). Definitive treatment for these conditions consist of resecting the scaphoid and performing a partial wrist fusion, or removing all 3 bones in the proximal carpal row. A styloidectomy is an acceptable alternative to more aggressive procedures in patients with low functional demands or those who wish to defer more definitive treatment.

Contraindications
The main risk following a radial styloidectomy is ulnar translocation of the carpus. Nakamura et al observed significantly increased radial translation with ulnar and palmar carpal displacement after 6- and 10-mm radial styloidectomies and therefore recommended a styloidectomy of no more than 3 to 4 mm. Ulnar translocation is a frequent sequella of longstanding rheumatoid disease hence any patient with chronic wrist involvement is a poor candidate for this procedure.

Surgical Technique (link to radial styloidectomy video).

This is one procedure where the 1-/,2 portal is particularly helpful for debridement (link to styloidectomy 2). The author also uses the VR portal interchangeably with the 3-/,4 portal in order to gain complete access to the dorsoradial aspect of the styloid. The marked cartilage loss can be seen on the adjacent surfaces of the scaphoid and radius (link to styloidectomy 3). The diameter of the burr will give a rough guide as to the amount of bony resection, but this needs to be confirmed fluoroscopically (link to styloidectomy 4-6). Enough bone should be resected so that there is no residual impingement between the scaphoid and the radial styloid when the wrist is radially deviated with the traction released.

Postoperatively the patient is splinted for the first week followed by progressive wrist motion and strengthening. This is a temporizing procedure and may provide some limited pain relief for a few years. A more definitive procedure is often necessary over time.