Does Total Wrist Arthroplasty for Treatment of Posttraumatic Wrist Joint Osteoarthritis in Young Patients Always Lead to Restriction of High-demand Activities of Daily Living? Case Report and Brief Review of Recent Literature

Schmidt, Ingo

doi:10.2174/1874325001711010439

Cited by 8 publications

(13 citation statements)

References 43 publications

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“…It does not decrease range of motion in the wrist, has no limit in age of patients, preserves grip strength, still allows other procedures to be performed in the future, and longterm results have been recognized a satisfactory pain relief in up to 73% of cases accompanied with a stable pain relief over time in 89% of cases at a mean follow-up period of 77 months [25][26][27][28]. When the patients develop posttraumatic prolonged painful pancarpal wrist joint OA with or without prior denervation, TWF or the motion-preserving TWA is inevitable ( Figure 6A-B) [11,[29][30][31][32][33]. Recent evidence suggests that patients receiving TWA significantly better rated their functional outcome than patients receiving TWF, and the complication rate of TWA with 10% does not differ significantly to those with 7% in patients undergoing a TWF [34,35].…”

Section: Case Presentationmentioning

confidence: 99%

“…PUCT may occur as a primary traumatic ligamentous injury pattern with or without accompanying fractures or as complication after RCFDI [11]. Despite primary surgical repair of RCFDI, PUCT was observed in 23% of cases at an average follow-up of 2,8 years [12].…”

Section: Case Presentationmentioning

confidence: 99%

“…TWA for treatment of posttraumatic wrist joint OA has reported to be a relative portion of 14% of all TWAs performed by surgeons who have published their experiences with this procedure [36]. Additionally, TWA is not always focused for elderly patients with low-demand claims in activities of daily living [11,37]. However, patients undergoing treatment with TWA must be prepared that it might end with TWF; therefore limited bone resection is a common feature of all contemporary wrist replacements [38,39].…”

Section: Case Presentationmentioning

confidence: 99%

“…What are the salvage options with its special features in indication when patients develop posttraumatic painful wrist joint osteoarthritis? Trauma EmergWith the knowledge of the natural course of PUCT including its injury pattern and the poor outcome despite surgical repair, it must be emphasized with our patient that he will develop pancarpal wrist joint OA in the future; hence, it was and is recommended by the author to perform an early denervation of the wrist which obtains a satisfactory pain relief over a period of time [11]. This simple and fast procedure prior to a total wrist fusion (TWF) or a total wrist arthroplasty (TWA) is a suitable and reliable option.…”

mentioning

confidence: 99%

“…If RCDFI is diagnosed, surgical intervention either with CREF or ORIF should follow as soon as possible in order to avoid secondary complications related to a compartment syndrome. When luxation tendency in dorsal direction by a displaced dorsal rim fracture is present, ORIF is the method of choice to restore stability ( Figure 5A-D).PUCT may occur as a primary traumatic ligamentous injury pattern with or without accompanying fractures or as complication after RCFDI [11]. Despite primary surgical repair of RCFDI, PUCT was observed in 23% of cases at an average follow-up of 2,8 years [12].…”

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confidence: 99%

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Posttraumatic ulnar carpal translocation type I accompanied with disruption of the lunotriquetral ligament caused by a severe radiocarpal fracture-dislocation injury type II accompanied with complete luxation of the distal radioulnar joint. What are the salvage options with its special features in indication when patients develop posttraumatic painful wrist joint osteoarthritis?

Schmidt¹

2017

Trauma Emerg Care

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Key words: radiocarpal fracture-dislocation injury, dorsal rim fracture distal radius, luxation distal radioulnar joint, posttraumatic ulnar carpal translocation, volar intercalated segment instability, denervation of the wrist, salvage options for posttraumatic wrist joint osteoarthritis Case presentationA 24-year-old right-handed male sustained a severe closed right radiocarpal fracture-dislocation injury (RCFDI) due to high-energy fall on his hyperextended wrist by a motorcycle accident with speed of 102,5 miles per hour. The initial radiographs showed complete dislocation of the wrist in dorsal direction accompanied with a displaced dorsal rim fracture of the articular surface of distal radius, a displaced intraarticular radial styloid fracture involving much more than one third of the articular surface of distal radius (type II), and complete luxation of distal radioulnar joint (DRUJ) in volar direction (Figure 1). Accompanying visceral, vascular or nerve injuries were not present, but closed non-displaced fractures of the left metatarsal bones II/III. First, the closed reduction and external fixation (CREF) of the wrist and DRUJ with additional radioulnar transfixation using two K-wires was performed. The postoperative computed tomography (CT) scans demonstrated complete restoration of anatomic alignment in both joints ( Figure 2A). Five days after that, the swelling around the wrist had improved, and so, the open reduction and internal fixation (ORIF) of radial styloid fracture using two 3,0 mm cannulated headless titanium compression screws (medartis®, Basel/Switzerland) could be performed that was accompanied with removal of external fixation and early denervation of the wrist ( Figure 2B). Intraoperatively, there was no radiocarpal re-luxation tendency in dorsal direction related to the accompanying dorsal rim fracture, and so its surgical reduction was not necessary. The right upper extremity was immobilized with a plaster splint involving the elbow and wrist joints for another five weeks. After that, the plaster splint and the two K-wires for radioulnar transfixation were removed, and the movement of the wrist was freed accompanied with pain-related gradual increase of load. The left non-displaced fractures of the metatarsal bones II/III were treated conservatively with a plaster splint for six weeks. Fourteen weeks after injury, the patient could be reemployed completely in his original occupation as a mechanic in a professional motorcycle racing team. At the 1-year follow-up, the postero-anterior (PA) and lateral radiographs showed distinctive posttraumatic ulnar carpal translocation (PUCT) of the entire carpus (type I) in comparison to the uninjured left wrist that was accompanied with marked volar angulation of the scaphoid bone in the absence of disruption of scapholunate ligament (SLL), but in the presence of disruption of the lunotriquetral ligament (LTL) with distinctive volar intercalated segment instability (VISI) ( Figure 3A-B). However, the patient rated his pain in visual analogue score ...

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