An alternative technique for revision arthrodesis of the rheumatoid wrist: A case report

Mohty, Atef; Hassan, Douglas M.; Shapiro, Steven L.; Greene, David L.

doi:10.1053/jhsu.2001.20970

The Journal of Hand Surgery

2001

DOI: 10.1053/jhsu.2001.20970

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An alternative technique for revision arthrodesis of the rheumatoid wrist: A case report

Atef Mohty

Douglas M. Hassan

Steven L. Shapiro

et al.

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Cited by 2 publications

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“…13,14 The method is technically demanding and augmentation with iliac crest grafts, allografts, or even transplantation of fibularfree flaps is required when there are severe bone defects. 13,14 The method is technically demanding and augmentation with iliac crest grafts, allografts, or even transplantation of fibularfree flaps is required when there are severe bone defects.…”

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confidence: 99%

Replacement With Silicone Wrist Implant After Failed Silicone Wrist Arthroplasty

Schindele

Kolling²,

Reissner³

et al. 2012

Techniques in Hand &Amp; Upper Extremity Surgery

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Revision surgery after failed silicone wrist arthroplasty is often challenging. In particular, in cases of inflammatory arthritis there is a high incidence of extensive bone loss which leads to a high complication rate in wrist fusion as a salvage procedure. Sometimes the surgeon may be faced with a patient in poor overall medical condition, who is very low demand so that the complexities of wrist fusion after a failed silicone arthroplasty may be contraindicated. For that situation, revision with a silicone prosthesis is a easy method in cases of severe osseous destruction in low demand patients with a long history of inflammatory arthritis.With 3 case reports will describe the topic of replacement with silicone wrist implant after failed silicone wrist arthroplasty.

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mentioning

confidence: 99%

Replacement With Silicone Wrist Implant After Failed Silicone Wrist Arthroplasty

Schindele

Kolling²,

Reissner³

et al. 2012

Techniques in Hand &Amp; Upper Extremity Surgery

View full text Add to dashboard Cite

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Wrist Arthrodesis

Hayden

Jebson

2005

Hand Clinics

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Wrist arthrodesis results in a high degree of patient satisfaction and predictable pain relief in most patients. Most patients are able to return to gainful employment, many without impairment. Some patients require restrictions and employment in a less strenuous occupation. Successful fusion rates have been reported in the vast majority of patients overall. Although the functional outcome is acceptable for most patients,some adaptation is necessary, because certain activities such as perineal care and manipulating the hand in tight spaces are difficult. Activities that require forceful gripping with the hand ina fully pronated or supinated position also may be difficult to accomplish. Preoperative counseling of the patient should include a candid discussion of the potential postoperative functional difficulties. The most common indication for a wrist arthrodesis is advanced symptomatic arthritis secondary to a degenerative, post-traumatic, inflammatory, or postinfectious condition. Wrist arthrodesis also may improve function, hygiene,and cosmesis in the patient who has a contracted or flail wrist associated with cerebral palsy, traumatic brain injury, or brachial plexus injury.Various techniques have been described for achieving a successful arthrodesis. The type of operative technique used depends on the underlying condition, quality of bone, presence of bi-lateral disease, condition of the remaining joints of the involved extremity, and surgeon's preference. Intramedullary rod or Steinman pin fixation has been successful in patients who have inflammatory arthritis. Dorsal plate and screw fixation is preferred for patients who have post-traumatic or degenerative arthrosis. Rigid fixation with a dorsal plate is advocated because of the ease of implant application, the high rates of fusion achieved, and the avoidance of prolonged postoperative cast immobilization. Precontoured low profile plates have been developed to position the hand appropriately and to minimize extensor tendon irritation. Controversy still exists as to the ideal position of the hand. Generally the wrist is placed in slight dorsiflexion and ulnar deviation to optimize power grip. In cases of bilateral involvement, the nondominant hand may be placed in 5 degrees -10 degrees of flexion to better assist in such activities as perineal care. Complications are frequent but can be minimized with attention to detail and good surgical technique. Fortunately most complications are amenable to nonoperative treatment. Major complications include nonunion, deep wound infection, neuroma formation, DRUJ arthritis,ulnocarpal impaction, CTS, and painful retained hardware. Minor complications include hematoma formation, partial wound dehiscence, and transient paresthesias involving the radial, ulnar,or median nerves. Donor site morbidity remains a concern when the iliac crest is used. Complications include hematoma formation, infection, injury to the lateral cutaneous femoral nerve, and prolonged discomfort. Successful outcomes have been reported with the use o...

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An alternative technique for revision arthrodesis of the rheumatoid wrist: A case report

Cited by 2 publications

References 5 publications

Replacement With Silicone Wrist Implant After Failed Silicone Wrist Arthroplasty

Replacement With Silicone Wrist Implant After Failed Silicone Wrist Arthroplasty

Wrist Arthrodesis

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