Hand and wrist joint procedures in sclerodermic patients – a systematic review

Abstract

Hand reconstructive surgery in systemic sclerosis has long time been considered a taboo due to the frequent global stiffness and menaced wound healing associated with digital ischemia and skin tightness. We assumed that joint procedures to sclerodermic hands or wrists have not a higher rate of infection, wound healing problem or non-union in comparison to non-sclerodermic population. We systematically reviewed the literature assessing these complications after performing joint reconstruction in hands and wrists of sclerodermic patients. Studies were identified through systematic review of the available literature in the Pubmed Medline, Cochrane Central Register of Controlled Trials, Embase, Web of Science database up to May 3rd, 2017. Database was searched using a set of search terms, which described systemic sclerosis, bone and joint surgery, and hand or wrist surgery. Only studies including joint procedures in hands or wrists of sclerodermic patients that were related to the functional outcomes and morbidity after surgery were selected. Reviews were excluded. Studies relevant to soft tissue reconstruction in sclerodermic hands or wrists, such as digital sympathectomy, autologous adipose-derived stromal vascular fraction, vascular reconstruction or management of finger ulcers were also excluded. Results A total of 265 unique articles were identified in PubMed. Thirty-eight titles selected for abstract review. Twenty-nine abstracts did not meet the inclusion criteria or did not evaluate our predefined endpoint and were excluded. Nine articles were fully read and two more articles were considered irrelevant and excluded. Seven studies were deemed eligible for our systematic review. One hundred and sixteen sclerodermic patients were found. A total of 402 joint procedures in sclerodermic hand and wrist were exported. The operations concerned metacarpophalangeal and interphalangeal arthroplasty, joint replacement or fusion, Kapandji procedures, osteotomy of the finger and removal of the hardware. A low complications rate in terms of infection or digital ischemia after surgery was mentioned to all studies. In most of the cases, wound healing was uneventful and only in some cases, it was described slow. In cases of joint fusion, bone healing was successfully achieved. The functional outcome was reliable in all the cases. The wrist and hand joint procedures in systemic sclerosis were found to be reliable and related to low morbidity in terms of infection rate, wound healing and bone union. Results from future studies will unquestionably contribute to further establishment of knowledge about the therapeutic outcome after surgery in these suboptimal conditions of the sclerodermic hand.