Triquetrohamate arthrodesis for midcarpal instability

Abstract

To assess our results in the management of midcarpal instability with limited wrist arthrodesis, we retrospectively reviewed the records of 10 patients (11 wrists) who had undergone triquetrohamate arthrodesis for symptomatic midcarpal instability. Diagnosis was based on ulnar-side wrist pain, maximum tenderness over the triquetrohamate joint, and characteristic findings on cineradiographic examination. In nine patients, the proximal carpal row suddenly snapped into extension as the wrist was manipulated from radial to ulnar deviation. In one patient (both wrists), the distal carpal row could be dorsally subluxed by direct pressure and axial compression. Both these maneuvers reproduced the patients' symptoms. All cases had failed to improve with prior nonoperative treatment or soft tissue reconstruction. Triquetrohamate arthrodesis was performed to provide midcarpal joint stability. The follow-up time averaged 26 months (range, 6-72). There were two excellent, four good, three fair, and two poor results. Compared to the contralateral side, range of motion averaged 55% flexion, 69% extension, 61% radial deviation, and 64% ulnar deviation, and grip strength averaged 64%. The stability provided by triquetrohamate arthrodesis failed to control symptoms in almost 50% of cases.