gms | German Medical Science

Objectives/Interrogation: Wrist arthroscopy is technically demanding and complications-prone procedure due to intricate wrist anatomy and the steep learning curve. Published evidence suggests inverse relationship between the surgeon's experience and complication rate. This audit analysed the case-mix and outcomes of all arthroscopies performed by a single surgeon since the introduction of the wrist service within a busy plastic surgery hand unit, as well as the challenges faced during this novel process.

Methods: 113 consecutive primary arthroscopies were carried out over the 9-year period (2009 -2018). 62% of the procedures were diagnostic and 38% therapeutic. The triangular fibrocartilage complex pathology was the commonest indication for investigation (47% of cases), followed by the scapho-lunate ligament injury in 27% and scaphoid fractures in 21%.

Results and Conclusions: There were no major complications - infections, neuromas, tendon or nerve injuries - in this cohort. A total of 7 (6%) minor complications were identified, 5 of which were in the first 4 years of the surgeon's practice. Iatrogenic partial thickness cartilage damage was observed intraoperatively in 6 patients (5%), all of whom were asymptomatic postoperatively. One localised postoperative synovitis at the site of 3/4 portal required subsequent surgical exploration and excision.

The first 100+ wrist arthroscopies carried out in our department have been delivered safely with complication rate comparable to that published worldwide. Wrist arthroscopy requires targeted subspecialist training, but with ongoing education and growing experience, it becomes safer and invaluably broadens the referrals to plastic surgery hand units. Lessons learnt will be covered as input to the colleagues involved in a similar practice setup.