Long-Term Follow-Up Evaluation of Denervation of the Wrist

Schweizer, Andreas; Känel, Oliver von; Kammer, Erich; Meuli‐Simmen, Claudia

doi:10.1016/j.jhsa.2005.12.012

Cited by 94 publications

(66 citation statements)

References 25 publications

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“…The best results were seen in patients with SLAC wrists. The authors concluded that this simple fast procedure does not decrease range of motion (ROM) and leaves all other surgical options open [16].…”

Section: Wrist Denervationmentioning

confidence: 99%

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis

Shah

Stern

2013

Curr Rev Musculoskelet Med

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Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the two most common patterns of posttraumatic wrist arthritis. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. Classic as well as newer innovative techniques are discussed with clinical outcomes in order to provide an evidence-based review of the world's literature on SLAC/SNAC wrist.

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Section: Wrist Denervationmentioning

confidence: 99%

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis

Shah

Stern

2013

Curr Rev Musculoskelet Med

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“…This simple and fast procedure prior to a total wrist fusion (TWF) or a total wrist arthroplasty (TWA) is a suitable and reliable option. 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].…”

Section: Case Presentationmentioning

confidence: 99%

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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“…Bereits 1966 von Albrecht Wilhelm [15] beschrieben, ist es verwunderlich, dass es lediglich eine Untersuchung zu Langzeitergebnissen nach kompletter Handgelenkdenervation gibt, obwohl verschiedene Autoren [2, 4-6, 8, 9, 11-14] seither über ihre Erfahrungen mit dieser Operationsmethode berichteten. Schweizer et al [14] erfragten anhand eines per E-Mail verschickten, erweiterten DASH-Fragebogens ohne klinische oder radiologische Untersuchung die subjektive Einschät-zung bei 70 (64%) von 109 operierten Patienten nach durchschnittlich 9,6 (1-23) Jahren.Das Ziel dieser retrospektiven Studie war es, in einer Langzeituntersuchung neben anamnestischen Daten klinische und radiologische Befunde zu erheben und auf der Basis dieser Daten retrospektiv die Indikation zur Handgelenkdenervation zu überprüfen. …”

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“…In der vorliegenden Arbeit wiesen Patienten mit fortgeschrittener Arthrose tendentiell bessere Ergebnisse auf, als Patienten ohne degenerative Veränderungen. Schweizer et al[14] beobachteten mit zunehmender Dauer des Verlaufsintervalls einen abnehmenden DASH-Score, während sich in dieser Studie ein tendenziell ansteigender DASH-Score mit zunehmender Dauer des Verlaufsintervalls ebenfalls ohne statistische Signifikanz fand (p=0,073).In der vorliegenden Untersuchung konnte statistisch keine signifikante Korrelation zwischen der Schwere der Arbeitstätigkeit einerseits und dem DASH-und Mayo-Wrist-Score andererseits festgestellt werden, was dafür sprechen mag, dass manuell schwer arbeitende Patienten nach kompletter Handgelenkdenervation keine schlechteren Ergebnisse gegenüber manuell leicht Arbeitenden erzielen. Zudem fand sich keine statistisch signifikante Korrelation zwischen dem Alter der Patienten einerseits und dem DASH-und Mayo-Wrist-Score andererseits.…”

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