Partial Wrist Denervation for Management of Post-traumatic Wrist Arthritis

Abstract

Symptomatic post-traumatic wrist osteoarthritis can occur after distal radius or carpal fractures or ligamentous injury and results in a predictable pattern of subsequent articular degeneration. Most commonly, this includes patients with radiocarpal arthritis after distal radius fracture, scaphoid nonunion advanced collapse and scapholunate advanced collapse. Patient can be considered for surgery after failure of at least 6 months of conservative treatments focusing on activity modification, splinting, oral anti-inflammatory medications or intra-articular corticosteroid injections. Multiple surgical options for the management of post-traumatic arthritis exists including carpectomy, partial or total arthrodesis, arthroplasty and denervation techniques. While partial or total wrist arthrodesis have demonstrated excellent outcomes with regards to pain, they are typically considered salvage options because of an associated loss of wrist motion. When compared to limited or total arthrodesis procedures, wrist denervation offers pain relief while preserving motion with shorter convalescent time and avoids potential complications associated with arthrodesis procedures including nonunion and need for subsequent revision surgery.