Selective arthrodesis in wrist instabilities: indications and surgical techniques

Abstract

The causes of deforming arthritis of the hand are ligament injuries associated with subluxations and luxations, fractures of the carpal bones, malunions, and osteoarticular diseases as Kienbock disease. There are many surgical interventions to resolve these problems (D. Green) Materials and methods Our experience is based on the treatment of 134 patients with deforming osteoarthritis of the wrist who underwent various selective arthrodesis. The average duration of disease was 3 years. Kienbock disease was diagnosed in 41 patients, pseudoarthrosis of the scaphoid complicated by deforming osteoarthritis - in 68 cases, rotational subluxation of the scaphoid - in 9 cases, trapezium-trapezoid-scaphoid osteoarthritis – in 4 patients and malunion of the radius fracture – in 4 cases. Results and discussions Nowadays deforming arthritis occurred in the wrist more often requires surgical treatment. Arthrodesis directed to obtain an ankylosis of the carpal bones by losing the amplitude of movements allows to achieve a stable joint, without pain and to restore gripping power. In 68 patients with scaphoid pseudoarthrosis complicated with deforming osteoarthritis, arthrodesis of "four carpal bones with scaphoidectomy" in 49 cases, total wrist arthrodesis in 7 cases, scaphocapitate arthrodesis in 3 cases, removing the first row of carpal bones in 3 cases, scaphoidectomy in 4 cases, radial-scaphoid arthrodesis – in 1 case, and in other scaphotrapezium- trapezoid arthrodesis. In 41 patients with Kienbock disease, Graner operation was performed in 16 cases, arthrodesis of "three 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 "three carpal bones” was performed in 4 cases of deforming arthritis of the scapho-trapezium-trapezoid joint. Triple scaphoid arthrodesis, arthrodesis of "three carpal bones” was done successfully on 9 patients with rotational subluxation of the scaphoid. Total wrist arthrodesis was performed in 4 cases of the intraarticular radial fracture malunion. Long-term 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. Conclusion: Selective wrist arthrodesis is indicated in deforming arthritis grade II or III of diverse etiology.