Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature

Abstract

Background: Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages. Aims: The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures. Methods: In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist. Results and Conclusion: Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.

Update to the difficulties in diagnostic and therapeutic management of the rare carpometacarpal joint II-V dislocation injuries: Case presentation and review of literature

“…For the recovery of polytraumatized patients it is absolutely necessary to achieve the earliest possible mobilization involving their independence in daily life for example to perform body hygiene that requires sufficient wrist motion [1]. The extension-flexion motion arc is realized with a relative portion of approximately 50% of both in radiocarpal and midcarpal joint, and for radial-ulnarduction the opposite shift of the proximal carpal row is needed [32]. Therefore, it is recommended that the K-wires should not cross the midcarpal joint, and additionally in order to avoid a breakage of the K-wires if wrist motion is freed.…”

Polyarthrose der Hand

“…Eine endoprothetische Versorgung des Handgelenkes bieten hingegen nur wenige spezialisierte handchirurgische Zentren an. Entscheidend für das langfristig gute funktionelle Ergebnis und das Überleben der Prothese in situ ist die Balancierung der artikulären und periartikulären Strukturen und die Einhaltung der Gelenkschutzmaßnahmen durch den Patienten [13,14].…”

"Off label" use of the ReMotionTM total wrist for treatment of advanced stage of post-traumatic pancarpal wrist osteoarthritis: Report of two cases and review of literature

“…The main postoperative problem with the ReMotion as well as with Universal 2 is worsened radial deviation that can be associated with development of painful radial-side impingement between the distal scaphoid and the offset of radial component, and only removal of the entire scaphoid is able to avoid this symptomatic impingement, but this procedure can cause an insufficient bony wrapping of the proximal threads of the radial-side screw (Figures 4A-C) [23,28,29]. Of all third generation types, only the Maestro achieved improvement of radial deviation in the absence of radial-side impingement [20,30,31]. This advantage with the Maestro was based on design-related features: (1) it had a concave to distally curved carpal component design (i.e.…”

“…This advantage with the Maestro was based on design-related features: (1) it had a concave to distally curved carpal component design (i.e. tapered), and (2) the three available sizes of intercalated carpal heads allowed more better restoration of resection-related carpal height than the ReMotion with it two sizes only [18][19][20]28].…”

“…Noted that mid-to long-term outcomes of primary TWF revealed a complication rate ranging from 33 to 60.5% associated with a required re-operation rate ranging from 19 to 63% with a reported predominance in females suffered from inflammatory disease, respectively [14][15][16][17]. From all 3rd generation TWAs the Maestro was superior both in terms of longevity and functional outcome over the other types, however, this implant was withdrawn from the marketplace because it was no longer profitable for the company, and now surgeons have explanation misery to their patients [18][19][20][21][22].…”