gms | German Medical Science

Background: Despite a high complication rate when looking at long term follow-up, RSL fusion is a therapeutic option for arthritis affecting the radioscaphoid and radiolunate joints. However, its role in management of SLAC wrist remains poorly defined and RSL fusion for the SLAC type II wrists is not an option commonly discussed. Indeed, the mainstays of treatment for this condition remain proximal row carpectomy (PRC) or four corner fusion.

Objectives and interrogation: The objective of this study was to determine if there were differences in outcome for RSL fusion when performed for SLAC II wrist as compared to that performed for post traumatic radiocarpal OA (PTRO).

Methods: Patients who had undergone RSL fusion for either SLAC II wrist or PTRO joint were identified from surgeons' records. Data collected included patient demographics, co morbidities, operative data and postoperative complications. Participants were asked to complete DASH and PRWE questionnaires. They were also asked to rate level of pain on a VAS as well as satisfaction score. Objective functional outcomes were measured in terms of range of motion at the wrist and grip strength. Follow-up x-rays were also performed.

Results and Conclusions: Flexion-extension arc was better in the SLAC group and radio-ulnar deviation better in the PTRO group though none reached statistical significance (p>0.05). Grip strength (both as an absolute value and as percentage of uninjured side) was better in the SLAC group and came to statistical significance. Functional measures of DASH and PRWE were also better in the SLAC group.

There was no significant difference in Pain VAS score or satisfaction in either group. Both groups scored low for pain and high for patient satisfaction. Analysis of the follow up x-rays indicated that all those which had not gone onto complete wrist fusion demonstrated successful bony union.

RSL fusion when performed for PTRO can be a very effective procedure in terms of range of motion, functional outcome assessment and patient satisfaction. When SLAC is the indication for surgery the results would suggest that FCF is superior. Indeed, when we compare our results to published series and that performing RSL fusion in a SLAC wrist is more technically demanding, FCF would seem to remain the better option for SLAC wrist.