Artikel
Distal radioulnar joint replacement with wrist arthrodesis a long term follow up
Suche in Medline nach
Autoren
-
Jesse Jupiter
- Massachusetts General Hospital, Harvard Medical School, Boston, United States
| Veröffentlicht: | 6. Februar 2020 |
|---|
Gliederung
Text
Objectives/Interrogation: Radiocarpal or midcarpal arthritis can occur in association with arthritis of the distal radioulnar joint (DRUJ). Surgical correction may include partial or total wrist arthrodesis as well as simultaneous or staged reconstruction of the DRUJ. While the semi-constrained total DRUJ prosthesis has been proven successful for a number of problems of the DRUJ, prior or even simultaneous wrist arthrodesis may present additional technical problems. These include the need for further interosseous membrane release in order to gain better access to the medullary canal of the ulna. If simultaneous procedures are to be considered, which should go first and will the added exposure create risks for soft tissue healing.
Methods: From 1998-2012 15 patients had an arthrodesis of the wrist either followed by or together with a total DRUJ prosthesis. Eight male and 7 female patients were retrospectively reviewed with the dominant limb involved in 11. The average age of the patients at the time of the DRUJ procedure was 45 years with 11 involving posttraumatic conditions and 4 rhematoid arthritis. The average number of surgical procedures prior to the DRUJ implant was 9. Twelve had the wrist fusion before and 3 after total wrist arthrodesis.
Results and Conclusions: The average follow up was 7 years (range 1-15 yrs). All patients had statistically significant improvement in forearm rotation with 11 having complete forearm function. All patients had a significant decrease in pain at rest and during exercise. The mean DASH score improved from preoperative 77 to postoperative 24 (p<0.01). Complications included later surgery for ulnar sided wrist pain including pisiform excision (3) and triquetrum excision (2). Superficial infection occurred in 2 patients treated with oral antibiotics and one deep infection requiring implant removal and staged reinsertion without recurrence.
While technically challenging, total semi-constrained DRUJ prosthesis can be effective either after or before total wrist arthrodesis.
