Intracarpal Arthrodesis Research Articles

Intracarpal arthrodesis or proximal row carpectomy in SNAC and SLAC wrist

Objective: To clarify the indications for the choice of operative intervention in patients with SLAC and SNAC wrist and to compare the functional results after proximal carpectomy (PRC) and partial intracarpal arthrodesis with scaphoid excision. Methods: A total of 20 patients underwent four corner fusion intracarpal arthrodesis with scaphoid excision, and 8 patients underwent proximal carpectomy in the period from 2016 to 2023. The mean postoperative follow-up period for patients with intracarpal arthrodesis was 3.2 years and for patients with proximal carpectomy was 3.5 years. Results: Regarding range of motion of the wrist in the flexion-extension axis, the proximal carpectomy patients in our series showed better results than the intracarpal arthrodesis patients, an average of 84% in the PRC patients and 75% in the intracarpal arthrodesis patients relative to the contralateral limb. In the patients with intracarpal arthrodesis, however, we recorded a greater preserved range of motion in the radial-ulnar deviation axis of the wrist. Grip strength was measured at 6 months postoperatively and averaged 72% for the PRC group compared with 83% for patients with intracarpal arthrodesis to the contralateral limb. Conclusion: Both proximal carpectomy and intracarpal arthrodesis are surgical interventions that achieve similar functional outcomes for the treatment of degenerative conditions of the wrist (SLAC/SNAC).

Treatment of Stages IIIA and IIIB in Kienbock's Disease: A Systematic Review.

Background Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease. Purpose This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease. Methods A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging. Results A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion. Conclusion In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.

Denervation of the wrist with two surgical incisions. Is it effective? A review of 33 patients with an average of 41 months’ follow-up

The goal of wrist denervation is to decrease pain at the wrist, whether caused by an intra- or extra-articular problem or even when the reason for the pain is unknown. It is an alternative to partial or total arthrodesis and proximal row carpectomy. Our hypothesis was that wrist denervation with a two-incision technique was a reliable and efficient way to treat painful degenerative wrists. Thirty-three patients, 48years old on average, were included in this study. Indications were scapholunate advanced collapse (SLAC) in 18 cases, scaphoid nonunion advanced collapse (SNAC) in 10, distal radius fracture sequelae with advanced radiocarpal osteoarthritis in 4, and post-traumatic ulnocarpal impingement in 1 case. At 41 months’ follow-up (12–161), there was a 75% reduction in pain levels, decreasing from 7.1 to 1.8 on a visual analog scale (VAS). There were no modifications related to wrist range of motion or grip strength. The QuickDASH averaged 23 points (5 to 70). Radiographic evaluation showed progression of intracarpal degeneration in 6 patients. All but 2 patients returned to their previous work. Persistent dysesthesia was observed in 7 patients; it resolved in 3 cases and persisted in 4. One patient developed complex regional pain syndrome (CRPS). A midcarpal arthrodesis with scaphoidectomy was performed in one patient because of disabling pain 5months after surgery. Wrist denervation with a two-incision technique for post-traumatic osteoarthritis led to satisfactory results in 75% of cases with reduction in pain, preservation of range of motion and grip strength. However, this technique does not stop the progression of osteoarthritis. It can be discussed as a therapeutic alternative to proximal row carpectomy or intracarpal arthrodesis to treat degenerative painful wrists. Type of study/level of evidenceTherapeutic IV.

The Management of Kienböck Disease: A Survey of the ASSH Membership.

Background The purpose of this study was to determine the current trends and common practices for the treatment of Kienböck disease at different stages. Question/Purpose To determine the current trends and common practices by hand surgeons for the treatment of Kienböck disease. Methods A survey with hypothetical Kienböck disease cases stratified by the Lichtman staging system was distributed to the American Society for Surgery of the Hand (ASSH) members. Questions and responses reflected common treatment strategies. Results Of a total of 375 worldwide respondents, preferred treatments of Kienböck disease were as follows: for Stage I disease, an initial trial of splinting was favored (74%), followed by radial shortening osteotomy for continued symptoms. For Stage II disease, 63% of surgeons preferred surgical intervention, particularly radial shortening osteotomy. For Stage IIIa with negative ulnar variance, 69% chose radial shortening osteotomy. Responses were heterogeneous for Stage IIIa Kienböck with positive variance, and capitate shortening osteotomy and vascularized bone grafting were preferred. Salvage procedures predominated for Stage IIIb disease, including proximal row carpectomy (PRC; 42%), intracarpal arthrodesis (21%), and total wrist fusion (10.7%). Similarly, Stage IV disease was treated by 87% of respondents by either PRC or wrist fusion. Without regard to stage of disease, 90% of participants reported using the same Lichtman staging to guide treatment and would also alter treatment strategy based upon ulnar variance. Conclusions Most respondents used Lichtman staging and ulnar variance to guide treatment decisions. Results indicate that the most common surgical treatments were radial shortening osteotomy for early disease and PRC in later stages. Level of Evidence Level IV, Economic/Decision Analysis.

L’arthrodèse capitato-lunaire par hauban dans l’arthrose du poignet: À propos de vingt cas au recul moyen de 4 ans

Purpose of the study Treatment of degenerative osteoarthritis of the wrist is aimed at preserving wrist motion and force while reducing pain. Limitation of the degenerative processes to certain joints raises the possibility of intracarpal arthrodesis, e.g. capitolunate arthrodesis. We present results of this procedure with a tension band wire in patients with arthritic degenerative disease of the wrist. Material and methods The series included 20 patients reviewed at mean 47 months. Mean age was 53.5 years. Pain was the main complaint. Wrist force and motion were decreased in all patients. All patients presented osteoarthritic disease of the wrist with preservation of the radiolunate space. The operation consisted in total scaphoidectomy and capitolunate arthrodesis maintained with a tension band wire. Force, pain (Mayo clinic score) and force (Jamar dynamometer) were recorded. The Cooney function score was determined and six patients completed the French Dash questionnaire. Radiolunate and capitolunate angles were noted as well as the index of carpal height measured preoperatively and at last follow-up. Results Nineteen of the 20 arthrodeses fused. A revision graft was successful for the one nonunion. Pain was the only clinical factor which improved significantly (p < 0.0001) in all patients. Lunatum extension (DISI) and capitatum flexion did not have any effect on functional outcome. Sixteen patients resumed their activities at the same level. Discussion The results of this series are similar to those in the literature concerning four-way arthrodesis. Capitatolunate arthrodesis with partial arthrodesis of the carpus has been proposed for arthritic degeneration of the wrist with a preserved radiolunate space. We prefer this procedure to four-way arthrodesis because useful motion and wrist force are preserved with constant and effective significant pain relief.

Le lambeau interosseux antérieur dans la chirurgie du poignet et de la main : à propos de 15 cas

Fifteen anterior interosseous flaps were used to reconstruct wrist and hand defects in fifteen patients (thirteen men and two women) with a mean of 38 years (27-42 years). Seven anterior interosseous osteoperiosteal flaps and eight anterior interosseous osteocutaneous flaps were used. Seven island flaps and eight free flaps based on the anterior interosseous artery were raised. The indications were scaphoid non-union (4 cases), first metacarpal non-union (2 cases), proximal phalanx non-union (1 case), Kienböck's disease (2 cases), osteocutaneous phalangeal defects (3 cases), osseous capitatum defect (1 case) and intracarpal arthrodesis (2 cases). Postoperatively, one fracture of the distal end of the radius was noted because of a large osteoperiosteal corticotomy. Osseous reconstruction was usually consolidated at three months. One failure was noticed (Kienböck's disease). No significant deformity was noticed in the donor site. The anterior interosseous flap seems to be a useful alternative to reconstruct small or moderate defects in wrist and hand surgery.

La dénervation articulaire, une réponse simple à des problèmes complexes de chirurgie de la main

In patients with preserved mobility and stability a painful joint remains a difficult problem, especially in elderly patients. All operations, including intracarpal arthrodesis, reduce an already limited mobility, require prolonged immobilization and have a high rate of complications. Denervation could be proposed in such cases. In our study denervation was performed on 132 wrists, 36 first carpo-metacarpal joints and 32 proximal inter-phalangeal joints. We have been disappointed in the past by partial wrist denervations. Fifty cases of complete and isolated wrist denervation were reviewed with a mean 5-year followup. Strength and mobility were only marginally improved but pain was decreased by a mean 75% (on a visual analog scale) in 74% of patients. At the proximal inter-phalangeal joint level, the mean pain improvement was 88% in 85% of patients. At the first carpo-metacarpal joint level, results of denervation were less predictable and the mean pain improvement was 67% in 81% of patients, with a mean 17-month follow-up. Joint denervation is a simple but precise operation performed under local anesthesia and on an outpatient basis. It provides good results in elderly patients, with few complications.

Entstehung und formen der posttraumatischen karpalen instabilität

Posttraumatic carpal instabilities may be caused either by fractures or by rupture of the ligaments and originate mostly from a sudden fall on the hand risen in defense. In this case forced dorsiflexion, supination and ulnarduction will be developed in the wrist joint and intracarpal region. The injury takes its course in four stages. According to the localisation we differ between radial carpal instabilities, which develop especially in the stages I and II, ulnar instabilities, which develop in the stages III and IV. Furthermore there exists a third kind of instability: the proximal carpal instability, which is localised in the radiocarpal joint. In addition to that we differ static and dynamic instabilities. For treatment in recent injuries the continuity of the ligaments and the shape and the size of the carpal bones are restored. In delayed cases it will be necessary to restore the ligaments by grafting, to perform intracarpal arthrodesis or osteotomy to correct the bony configuration.