Radioscapholunate Fusion Following Comminuted Fractures of the Distal Radius

Abstract

Radioscapholunate (RSL) arthrodesis must be considered an appropriate procedure in painful radiocarpal arthrosis following comminuted fractures of the distal radius. Despite total wrist fusion, it offers the possibility to exclusively eliminate the destroyed articulation preserving a certain degree of motion in the midcarpal joint. Accordingly, 22 patients with painful posttraumatic arthrosis of the radiocarpal joint underwent RSL fusion between 1992 and 1998. Average follow-up was 18.7 months. Postoperatively, total range of wrist motion decreased by an average of 21° E-F and 6° U-R deviation. Average grip strength of the affected wrist improved from 31.9 to 51.1 kPa. There was a considerable decrease of pain during activity and at rest. Using the DASH questionnaire, an average of 25.7 points was reached. Radiologic examination revealed no major signs of arthritis at the midcarpal joint. In one patient, nonunion as well as reactivation of deep infection secondary to an infection sustained during surgical stabilization of the initial radial fracture were recorded. In our opinion, however, RSL fusion represents a good alternative to total wrist fusion, since valuable wrist motion is preserved.