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Lunatocapitate and triquetrohamate arthrodeses for degenerative arthritis of the wrist.
J Hand Surg Am. 2012 Jun; 37(6):1136-41.JH

Abstract

PURPOSE

Proximal row carpectomy and 4-corner arthrodesis are 2 well-established motion-preserving treatment strategies for scapholunate advanced collapse. In this study, we present an arthrodesis technique involving the capitolunate and triquetrohamate joints as another potential treatment option.

METHODS

From 2000 to 2009, 27 consecutive patients with degenerative scapholunate advanced collapse and scaphoid nonunion advanced collapse were evaluated prospectively and treated with scaphoid excision and intercarpal arthrodesis between the capitate and lunate and between the hamate and triquetrum. This cohort consisted of 18 men and 9 women, involving dominant-sided surgery in 20 of 27 patients. Two patients were active smokers, and 3 cases were work related. Average age at time of surgery was 55 ± 3 years, and average follow-up was 51 ± 7 months. Preoperative and postoperative range of motion, grip strength, and radiographic evidence of osseous union were documented. Standardized Patient-Rated Wrist Evaluation scores for both pain and function were collected.

RESULTS

Wrist extension and flexion were decreased after surgery by 17% and 25% respectively, yielding a 21% decrease in mean flexion-extension arc. There was no significant difference with regard to postoperative radial and ulnar deviation or mean coronal plane arc compared to preoperative values. Compared to the contralateral side, preoperative and postoperative grip strength were 53% and 70%, respectively. The average operative-sided grip strength increased by 27%. The mean Patient-Rated Wrist Evaluation pain score was 11 ± 3 (of 50). The mean Patient-Rated Wrist Evaluation functional score was 17 ± 5 (of 100). Complications included 1 nonunion (yielding a 96% fusion rate), 1 median neuropathy (which resolved), and 2 superficial wound infections (treated successfully with oral antibiotics).

CONCLUSIONS

Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes for the treatment for scapholunate advanced collapse and scaphoid nonunion advanced collapse.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22624782

Citation

Wang, Mark L., and John M. Bednar. "Lunatocapitate and Triquetrohamate Arthrodeses for Degenerative Arthritis of the Wrist." The Journal of Hand Surgery, vol. 37, no. 6, 2012, pp. 1136-41.
Wang ML, Bednar JM. Lunatocapitate and triquetrohamate arthrodeses for degenerative arthritis of the wrist. J Hand Surg Am. 2012;37(6):1136-41.
Wang, M. L., & Bednar, J. M. (2012). Lunatocapitate and triquetrohamate arthrodeses for degenerative arthritis of the wrist. The Journal of Hand Surgery, 37(6), 1136-41. https://doi.org/10.1016/j.jhsa.2012.03.023
Wang ML, Bednar JM. Lunatocapitate and Triquetrohamate Arthrodeses for Degenerative Arthritis of the Wrist. J Hand Surg Am. 2012;37(6):1136-41. PubMed PMID: 22624782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lunatocapitate and triquetrohamate arthrodeses for degenerative arthritis of the wrist. AU - Wang,Mark L, AU - Bednar,John M, PY - 2011/05/28/received PY - 2012/03/13/revised PY - 2012/03/13/accepted PY - 2012/5/26/entrez PY - 2012/5/26/pubmed PY - 2012/10/25/medline SP - 1136 EP - 41 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 37 IS - 6 N2 - PURPOSE: Proximal row carpectomy and 4-corner arthrodesis are 2 well-established motion-preserving treatment strategies for scapholunate advanced collapse. In this study, we present an arthrodesis technique involving the capitolunate and triquetrohamate joints as another potential treatment option. METHODS: From 2000 to 2009, 27 consecutive patients with degenerative scapholunate advanced collapse and scaphoid nonunion advanced collapse were evaluated prospectively and treated with scaphoid excision and intercarpal arthrodesis between the capitate and lunate and between the hamate and triquetrum. This cohort consisted of 18 men and 9 women, involving dominant-sided surgery in 20 of 27 patients. Two patients were active smokers, and 3 cases were work related. Average age at time of surgery was 55 ± 3 years, and average follow-up was 51 ± 7 months. Preoperative and postoperative range of motion, grip strength, and radiographic evidence of osseous union were documented. Standardized Patient-Rated Wrist Evaluation scores for both pain and function were collected. RESULTS: Wrist extension and flexion were decreased after surgery by 17% and 25% respectively, yielding a 21% decrease in mean flexion-extension arc. There was no significant difference with regard to postoperative radial and ulnar deviation or mean coronal plane arc compared to preoperative values. Compared to the contralateral side, preoperative and postoperative grip strength were 53% and 70%, respectively. The average operative-sided grip strength increased by 27%. The mean Patient-Rated Wrist Evaluation pain score was 11 ± 3 (of 50). The mean Patient-Rated Wrist Evaluation functional score was 17 ± 5 (of 100). Complications included 1 nonunion (yielding a 96% fusion rate), 1 median neuropathy (which resolved), and 2 superficial wound infections (treated successfully with oral antibiotics). CONCLUSIONS: Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes for the treatment for scapholunate advanced collapse and scaphoid nonunion advanced collapse. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/22624782/Lunatocapitate_and_triquetrohamate_arthrodeses_for_degenerative_arthritis_of_the_wrist_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(12)00427-3 DB - PRIME DP - Unbound Medicine ER -