Wrist Hemiarthroplasty for Distal Radius Fractures

Abstract

Objective: Since 2005, we use a replacement and resurfacing prosthesis for complex intra-articular fractures of the distal radius. The prosthesis is composed of a radial stem and an epiphyseal-metaphyseal block articulating both with the carpal condyle and the ulnar head. This prosthesis is used in elderly and osteoporotic patients when reconstruction of the distal radius is too difficult, particularly when comminution and central impaction are associated. Materials and Methods: Since March 2005, 23 prosthesis were implanted on 23 patients (22 women and 1 man), the mean age was 77 years, from 38 to 102. Twenty-two cases concerned elderly and osteoporotic patients: 17 times for complex intra-articular fractures and 5 times for malunions. In one case, the procedure concerned a young man with a pathologic fracture (giant cell tumor). The patients were reviewed at 3 weeks, 6 weeks, 3 months, 1 year, and then each year. Results: Twenty patients came to follow up regularly. A patient operated in 2005 died in 2010; she retained a good result at the wrist. Two patients are lost at follow-up. The mean follow-up is 56 months, from 3 to 128 months. Seventeen patients are satisfied or very satisfied, and 3 patients are moderately satisfied. Twelve patients had no pain (Visual Analog Scale [VAS] = 0), and 8 patients complain of pain during strength activities or barometric pain. The Disability of the Arm, Shoulder and Hand (DASH) score is 26. The mean mobilities are as follows: extension 62°, flexion 37°, ulnar deviation 26°, radial deviation 21°, pronation 72°, and supination 68°. The mean strength was 79% of the contralateral strength. The implants are perfectly stable on the x-rays with a mean follow-up of 56 months. In 16 cases, we found periprosthetic ossifications. Wrist hemiarthroplasty for distal radius fractures is a simple solution for very complex problem. This concept allows the treatment of the most complex distal radius fractures with metaphyseal instability and intra-articular comminution. The clinical results are good, better, and quicker than those obtained with complex reconstruction surgery. Mobility is greater than that obtained with palliative surgery: radiolunate or radioscapholunate arthrodesis. The extension of the wrist allows these old patients to push up on their hands. Conclusions: The treatment of complex intra-articular distal radius fractures by an hemiarthroplasty of the wrist is a solution we can now use in elderly and osteoporotic patients. This solution must be known for distal radius tumors.