Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases

Abstract

We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept.

Kienbck's disease mimicing gouty monoarthritis of the wrist

“…An option for surgical treatment of stage IIIA (lunate collapse without scaphoid rotation) is callotasis lengthening of the capitate bone [9]. Another option for treatment of advanced stage of Kienböck's disease is motion-preserving TWA ( Figure 2A-B) with a portion of 2% of all TWAs performed by surgeons who have published their experiences with this procedure [10], and the relatively new angle-stable MaestroTM WRS that was used in our case presentation, is one of the modern biaxial-anatomical third generation type that is currently in use [11][12][13][14].…”

The MaestroTM Wrist Reconstructive System for treatment of posttraumatic wrist joint osteoarthritis after a devasting course of a distal radius fracture: Case presentation and technical note to the implant

“…Demanding physical occupations are not generally considered a contraindication for TWA [7,15]. The relatively new angle-stable Maestro TM WRS that was used in our case, is one of the modern biaxial-anatomical third generation type that is currently in use [7,8,[16][17][18]. This type is the further development of the non-angle stable Maestro TM Total Wrist that was developed in 2002 by Strickland / Palmer / Graham.…”

“…TWA has also resulted in a significantly better outcome than in patients who underwent a primary TWF [14]. Demanding physical occupations are not generally considered a contraindication for TWA [7,15]. The relatively new angle-stable Maestro TM WRS that was used in our case, is one of the modern biaxial-anatomical third generation type that is currently in use [7,8,[16][17][18].…”

“…Rates have been noted to range from 18-22% [1,2]. To avoid this high complication rate which has been associated with a significant negative impact on the patient's activities of daily living and independence in their personal, professional, and social environment, primary wrist hemiarthroplasty or early TWA after a failed primary osteosynthesis can be an option for the treatment of DRF especially in older and elderly patients [3][4][5][6][7][8]. However, long-term data using these procedures are not available currently.…”

“…This type is the further development of the non-angle stable Maestro TM Total Wrist that was developed in 2002 by Strickland / Palmer / Graham. The implant was designed for use in an uncemented manner, but it is recommended to insert the radial component with it titanium alloy stem with cementation if the bone stock is poor [7]. Such as in our case, the goal of both types is that the design allows the excision of the entire scaphoid bone accompanied with its replacement utilizing a carpal component that incorporates various scaphoid augments (Figure 2A).…”