Intercarpal Arthrodesis Research Articles

Kienböcks Disease

Kienböck's disease is an isolated disorder of the lunate resulting from vascular compromise to the bone. The symptoms include wrist pain, limited range of motion, and decreased grip strength. The diagnosis is made from characteristic changes seen in the lunate on radiograms of the wrist. The severity of the disease can be categorized by staging the degree of involvement. This is helpful in guiding the practitioner through the maze of treatment options. Initial treatment of Kienböck's disease is conservative and includes immobilization, analgesics, and/or anti-inflammatory medication. If symptoms are not relieved, then based on the degree of involvement, several surgical options exist that will provide a successful result. These include autogenous tendon replacement arthroplasty, revascularization, radial shortening, ulnar lengthening, limited intercarpal arthrodesis, and silicone replacement arthroplasty. Salvage procedures for Kienböck's disease include wrist denervation, wrist arthrodesis, and proximal-row carpectomy. Currently, we prefer immobilization for treatment of stage I Kienböck's disease. For stage II, a revascularization procedure may be attempted or ulnar lengthening/radial shortening done, particularly if there is significant negative ulnar variance. In stage III, replacement arthroplasty and/or limited intercarpal arthrodesis is our treatment of choice, and for stage IV, one of the salvage procedures is indicated.

Scaphoid-trapezium-trapezoid fusion in the treatment of chronic scapholunate instability

Limited intercarpal arthrodesis for chronic scapholunate instability has been the subject of several recent publications. We have followed nine patients, who had scapho-trapezio-trapezoidal (S-T-T) fusion for scapholunate instability. All nine patients were re-examined recently after an average follow-up period of 19 months (range, 12 to 25 months). Six of the nine patients believed that their symptoms were significantly improved. The postoperative range of wrist motion (ROM) was decreased in all directions of motion. The pinch strength averaged 86% on the treated side and the grip strength averaged 74% of the unoperated side. Review of follow-up x-ray films showed radiographic evidence of union in eight of nine patients. We conclude that, with careful patient selection and close attention to operative detail, S-T-T fusion can be an effective treatment for scapholunate instability. However, the results are not uniformly predictable, and neither range of motion nor strength is normal after the procedure.

Giant cell tumour of the triquetrum

A case of giant cell tumour involving the triquetrum is reported. Treatment consisted of resection of the triquetrum, followed by intercarpal arthrodesis.

Giant Cell Tumour of the Triquetrum

A case of giant cell tumour involving the triquetrum is reported. Treatment consisted of resection of the triquetrum, followed by intercarpal arthrodesis.

Intercarpal arthrodesis in the management of chronic carpal instability after trauma

A retrospective review of five patients with chronic carpal instability resulting from trauma suggests that this condition can be successfully treated by intercarpal arthrodesis. Scaphoid-lunate fusion was used to treat chronic dorsal intercalary segment instability, while scaphoid-capitate-lunate fusion was used to treat chronic palmar intercalary segment instability. Results after intercarpal arthrodesis were consistently good, with restoration of painless function, preservation of grip strength, and a high degree of patient satisfaction. Although a fibrous union was obtained in two of the three scaphoid-lunate arthrodeses, this did not prejudice a good clinical outcome. These results compare favorably to those with other treatment modalities, including ligamentous reconstructions with tendons. Based on these findings, a more extensive clinical trial of intercarpal arthrodesis to treat chronic carpal instability appears warranted.

Giant cell tumor of the capitate

A case of giant cell tumor of the capitate is presented. Its recurrence and the problem of reconstruction after resection are discussed. Recommended treatment of this tumor if it occurs within the carpals is resection of the carpus with intercarpal arthrodesis if the distal row is involved or proximal row carpectomy if the scaphoid or lunate is involved.

L'instabilité médio-carpienne

The author reports his personal experience of eleven cases of midcarpal instability. Diagnosis was essentially based on dynamic radiological investigations of the wrist with distraction and posterior "drawer" movements. Damage to the anterior capsuloligamentous complex is the underlying cause. According to the predominance on the ulnar or radial side, one may speak of anteromedial or anterolateral midcarpal instability. Management differs in the case of recent injuries which should be treated on a nonoperative basis as compared to the case of longstanding lesions whose treatment is difficult. It seems as though only intercarpal arthrodesis is the solution to adequate stabilization of the lesions. To avoid loss of motion, the author suggests the possibility of palliative treatment by arthroplastic resection of the proximal row of the carpus, which, in this type of indication, seems to be a last resort.