Secondary Osteoarthrosis: Partial or Total Arthrodesis Versus Wrist Arthroplasty
Secondary osteoarthrosis of the wrist typically develops after intra-articular distal radius fractures with articular incongruity (step-off) of 1–2 mm or more or with an associated rupture of the scapholunate ligament. If the condition is painful and cons
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Michel E.H. Boeckstyns
Contents
41.1
41.1
Summary..................................................... 343
41.2
Treatment Options ..................................... 343
Conclusion ..............................................................
346
References ...............................................................
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Secondary osteoarthrosis of the wrist typically develops after intra-articular distal radius fractures with articular incongruity (step-off) of 1–2 mm or more or with an associated rupture of the scapholunate ligament. If the condition is painful and conservative measures fail, surgical treatment may be necessary. Total wrist fusion is the standard procedure but total- or hemi-wrist arthroplasty may also be used. Other motion preserving solutions are feasible, if the midcarpal joint is normal: total or partial radiocarpal fusion or a modified proximal row carpectomy, depending on the condition of the cartilage in the radioscaphoid fossa.
41.2
M.E.H. Boeckstyns, MD Clinic for Hand Surgery, Gentofte Hospital – University of Copenhagen, Copenhagen, Denmark e-mail: [email protected]
Summary
Treatment Options
Secondary osteoarthrosis (OA) of the wrist may result after a distal radius fracture (DRF) in which there are cartilage changes due to the intraarticular nature of the fracture (Fig. 41.1). Accurate reduction of the articular surface is a critical factor in avoiding this complication: articular incongruity of 1–2 mm or more carries a high risk of developing OA (Knirk and Jupiter 1986; Catalano et al. 1997; Fernandez et al. 1997). Associated scapholunate ligament disruption may lead to wrist instability and scapholunate advanced collapse (SLAC wrist), increasing the risk of OA. The radiographic presence of OA does not necessarily correlate with
L.M. Hove et al. (eds.), Distal Radius Fractures, DOI 10.1007/978-3-642-54604-4_41, © Springer-Verlag Berlin Heidelberg 2014
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Fig. 41.1 Secondary OA after intra-articular distal radius fracture
the functional outcome, but painful and disabling OA requires treatment. If the condition does not respond adequately to conservative treatment (anti-inflammatory medication, splinting and steroid injections), it may have to be treated surgically. Before making a decision of performing surgery on the radiocarpal joint, it is important to make sure that the pain is related to the radiocarpal joint and does not originate from the distal radioulnar joint, a TFCC lesion or ulnocarpal abutment. • Total wrist fusion (TWF) is the standard procedure for OA of the wrist from whatever
M.E.H. Boeckstyns
cause, including posttraumatic conditions, and patients may accommodate well for the loss of motion (Murphy et al. 2003). With the use of special wrist fusion plates (Fig. 41.2), the number of carpal or carpometacarpal nonunions is low (2–7 %) (Meads et al. 2003; Houshian and Schroder 2001). Nevertheless, TWF may have an important negative impact on the health status of patients with posttraumatic OA (Adey et al. 2005), and with
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