Dr Stuart Myers

Wrist Arthritis - Salvage Procedures

Wrist Arthritis - Salvage Procedures 


Indications:


- Wrist fractures
- Scaphoid Nonunions
- Fractures involving the wrist joint surface
- Wrist ligaments injuries
( eg Scapho-lunate ligament)
- Inflammatory arthritis eg Rheumatoid arthritis, Gout

Salvage procedures imply that normal wrist function cannot be achieved often because the original injury or condition has been complicated by damage to the joint cartilage (surfaces) in the wrist (arthritis).

                              



1. Wrist Arthroscopy
- Minor procedure
- Cannot cure arthritis but can remove spurs and loose bodies and loose pieces of cartilage

               

 

- Short term relief
- Day only procedure
- Splint until comfortable (few days)
- See Wrist Arthroscopy

2. Proximal Row Carpectomy

- Removes 3 bones from wrist ( Scaphoid, Lunate, Triquetrum)
- The Capitate comes to rest on the end of Radius and it rotates on a ligament on the front of the wrist.

          

 

Therefore it is important to make certain that:


1. There is no significant arthritis affecting the Capitate.


2. The Radio-Scapho-Capitate ligament is intact


The subsequent forces through the wrist are across a smaller unit area and therefore the contact stresses are greater.
This means that this procedure may be complicated by more arthritis 10-20 years later:
- Therefore may require full wrist fusion at a later stage
- Hospital stay overnight
- Plaster 6 weeks then splint for further 4 weeks
- Movement ~ 50* : 50*
- Takes 12 months to regain grip strength due to effective slackening of muscle bellies in the forearm
- Grip strength never returns normal ( ~ 80% normal at best )


3. Limited wrist fusion

- Removes scaphoid bone which is often the site of maximal arthritis
- The scaphoid is used as bone graft to stiffen the middle joint of the wrist
- A circular plate is used to maintain the position until bone healing has occurred
- Hospital stay overnight
- Plaster 6 weeks after operation then wrist brace until Fusion solid
- Movement ~ 50 : 30
- Strong grip as no slackening of muscles but may have occasional discomfort
- May require full wrist fusion at a later stage ( eg 20 years later )

 

         

                


4. Wrist fusion

- Completely prevents wrist from bending up or down or from side to side
- One can still rotate the forearm & move the fingers
- Strongest grip
- No pain
- A Plate is used to stiffen wrist (& rarely bone graft taken from hip)
- Hospital stay 2 - 3 days
- Plaster for 6 weeks then removable brace for further 4 weeks
- Indicated when wrist already fairly stiff
- Often the happiest patients

      

 

 


LAST UPDATED ON  1 / 4 / 2015