Abstract:
Introduction. Wrist joint instabilities are ligament injuries associated with subluxations,
luxations, fractures, nonunions or osteoarticular diseases of carpal bones. There are type of
surgery to resolve these problems.
Materials and methods. Our experience is based on the treatment of 129 patients with wrist
instabilities of different etiology aged between 17 and 68 years who underwent various selective
arthrodesis. The average duration of disease was 3 years and 2 months. Kienbock disease was
diagnosed in 41 patients, in various stages, pseudoarthrosis of the scaphoid complicated by
deforming osteoarthritis - in 71 cases, rotational subluxation of the scaphoid - in 9 cases,
trapezium-trapezoid-scaphoid osteoarthritis – in 4 patients and malunion of the distal radius
fracture – in 4 cases.
Results. Arthrodesis directed to obtain an ankylosis of the carpal bones by losing the amplitude
of movements, but allows to achieve a stable joint, without pain and to restore gripping power. In
71 patients with scaphoid pseudoarthrosis, complicated with deforming osteoarthritis, arthrodesis
of 4 carpal bones with scaphoidectomy in different variants was performed in 49 cases, total
wrist arthrodesis in 8 cases, scaphocapitate arthrodesis in 4 cases, removing the first row of
carpal bones in 3 cases, scaphoidectomy in 5 cases, radial-scaphoid arthrodesis – in 1 case, and 1
other in scapho-trapezium-trapezoid arthrodesis. In 41 patients with Kienbock disease, Graner
operation was performed in 16 cases, arthrodesis of 3 carpal bones in 10 cases, capitate-scaphoid
arthrodesis – in 8 cases, radial-semilunar – in 4 cases, radial-scaphoid arthrodesis – in 1 case,
removing the first row of carpal bones – in 2 cases. Arthrodesis of 3 carpal bones (scaphotrapezium-
trapezoid), was performed in 4 cases of deforming arthritis. Also triple scaphoid
arthrodesis was done successfully in 9 patients with rotational subluxation of the scaphoid. Total
wrist arthrodesis was performed in 4 cases of the intraarticular radial fracture malunion. Longterm
results were followed up in 46 patients: good (18), satisfactory (23). Unsatisfactory
outcomes were in 5 cases because of absence of the ankylosis and presence of the pain.
Conclusions. Selective wrist arthrodesis is indicated in deforming arthritis grade II or III of
diverse etiology, when outstanding amplitude movements are up to 50% of normal range.
Each case of selective wrist arthrodesis is chosen individually according to disease, the spreading
grade of deforming osteoarthritis and patient profession.
