Intercarpal arthrodeses

The effect of intercarpal arthrodeses on wrist kinematics during radial and ulnar deviation: a cadaveric study using four-dimensional CT

In this cadaveric study, we report quantitative dynamic four-dimensional CT evaluation of the effect on wrist kinematics of three intercarpal arthrodeses during radial and ulnar deviation. In five wrists, we successively performed scaphocapitate, four-corner and two-corner fusions. Four-dimensional CT examinations were performed prior to dissection and after each arthrodesis. The lunocapitate gap, posterior lunocapitate angle, radiolunate radial gap, radiolunate ulnar gap and radiolunate angle were assessed. After scaphocapitate arthrodesis, in radial deviation, we noted midcarpal diastasis and dorsal displacement of the capitate. In ulnar deviation, there was correction of that incongruence. After four-corner and two-corner fusions, in radial deviation, we noted radial radiolunate impingement and ulnar radiolunate incongruence. In ulnar deviation, after two-corner fusion, ulnar radiolunate impingement and radial radiolunate incongruence were present contrary to four-corner fusion. Our findings confirm that the constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after these arthrodeses.

Intercarpal arthrodesis: A systematic review

Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.

[Revision surgery after failed (partial-) arthrodesis of the wrist]

(Partial) arthrodeses of the wrist have been proven cornerstones to treat many lesions for decades, especially in the case of revision surgery. Four-corner, scapho-trapezo-trapezoidal (STT), radio-scapho-lunate (RSL) and total wrist fusions are very common techniques in hand surgery. However, even these proven surgical procedures have significant non-fusion rates. Prior to revising a failed arthrodesis, it is essential to analyse the latter failure precisely. A technically adequate revision is only feasible when based on a correct and meticulous analysis. The understanding of the biological processes and technical aspects of the implants are the basis for solving this issue.

First-stage scapholunate fusion for the treatment of a chronic lunate dislocation: A case report

RATIONALE

Lunate dislocation is a rare injury to the wrist caused by high-energy trauma, and poor prognosis is often associated with missed initial diagnosis. To date, there is no consensus regarding an effective treatment plan for such cases.

PATIENT CONCERNS

Here, we describe the case of a 36-year-old man who presented with lunate dislocation following a delay in diagnosis of over 7 weeks, and further illuminate its diagnosis and treatment.

DIAGNOSIS

The diagnosis of chronic lunate dislocation was rendered.

INTERVENTIONS

The patient was treated using reduction via the dorsal approach brachial plexus anesthesia. After the reduction, a headless compression screw fixation was performed for first-stage scapholunate fusion, and Kirschner wire fixation of the lunate-triquetrum-hamate was used to stabilize the distal and proximal carpal rows.

OUTCOMES

The patient was followed up for 1 year and showed wrist function recovered well; radiographic examination showed no lunate dislocation and successful scapholunate bony fusion. A satisfactory outcome was achieved.

LESSONS

The case study presented here provide evidence that performing an effective first-stage scapholunate fusion is recommended to achieve better therapeutic outcomes for a chronic lunate dislocation. Furthermore, this approach led to a good long-term clinical outcome in our case.

Optimal management of scapholunate ligament injuries

Scapholunate ligament (SLL) injuries are a common cause of wrist pain and instability. Treatment of SLL injuries requires intricate understanding of wrist anatomy and biomechanics. Mindful physical exam and appropriate diagnostic studies can orient the surgeon to the defined stage of injury. Review of the literature on each treatment by stage can prepare the upper extremity surgeon to provide the best evidence-based care. The optimal management of SLL injuries should result in a stable, painless wrist.

Intercarpal fusions: indications, treatment options and techniques

Partial wrist fusion is a useful technique for the treatment of such specific carpal disorders as arthritis, Kienböck's disease, midcarpal instability, scaphoid nonunion, etc.Many techniques have been described by removing arthritic joint surfaces and transfering load, using, for bone fixation, K-wires, screws, staples, and more recently dedicated plates.The goal of this procedure is to maximise wrist motion and strength while minimizing or eliminating pain.The purpose of this article is to discuss the most commonly used combination of intercarpal arthrodeses, to clarify the indications for each fusion, to describe the appropriate surgical technique for each fusion, and to provide an overview of results and current concepts. Cite this article: Houvet, P. Intercarpal fusions: indications, treatment options and techniques. EFORT Open Rev 2016;1:45-51. DOI: 10.1302/2058-5241.1.000019.