Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fracture in the Independent Elderly

Abstract

Background?Volar plating for acute distal radius fractures (DRF) in the elderly has been recommended. Some studies have suggested that open reduction with internal fixation (ORIF) in this situation results in frequent complications. Our purposes were to provide a definition of irreparable DRF in independent elderly patients and to review the results of a preliminary retrospective series of wrist hemiarthroplasty (WHA) in this patient population. Materials?Between 2011 and 2014, 11 consecutive independent elderly patients (12 wrists) with irreparable intra-articular DRF were treated with primary WHA at the acute stage. A resection of the ulnar head was associated in nine wrists. A total of 11 wrists with more than 2 years of follow-up form the basis of this paper. Description of Technique?The approach was dorsal longitudinal. An osteotome longitudinally entered the dorsal aspect of the fracture medial to the Lister tubercle. Two thick osteoperiosteal flaps were elevated radially and ulnarly in a fashion similar to opening a book. The distal radius articular surface was excised. The implant was pressed into the radial canal with attention to restoring distal radius length. The two osteoperiosteal flaps were brought back together and sutured so as to close, again like a book, the osseous and soft tissues around the implant. Results?At mean follow-up of 30 months, average visual analog scale (VAS) pain was 1/10. Mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 32, and mean Patient-Rated Wrist Evaluation (PRWE) score was 24. Mean forearm rotation arc was 151?. Mean active flexion-extension arc was 60?. Mean active extension was 34?. Mean grip strength was 14?kg (64% of contralateral wrist). Mean Lyon wrist score was 73%. Bone healing around the implants was satisfactory in all but one case. Conclusions?Out data suggest that treatment of irreparable DRF in the independent elderly patient with a bone-preserving WHA may be a viable option. Longer-term follow-up and comparative studies are needed to confirm the validity of this concept.

Lessons learned with the Cobra prosthesis in elderly patients with complex distal radius fractures—a retrospective follow-up study

“…Recent studies showed moderate results for wrist hemiarthroplasty in elderly patients following complex DRF [11][12][13][14][15][16][17][18][19][20]. The idea of hemiarthroplasty for this indication was first implemented by Roux in 2005 [11].…”

“…Additionally, the patients had to be aged 65 years or older and living at home performing activities of daily living independently. Surgical treatment was based on the technique described by Herzberg et al [12,21]. A longitudinal incision was made dorsally in line with the third metacarpal bone (Fig.…”

“…In 2009, Roux [11] published first results of a wrist hemiarthroplasty with the SOPHIA implant (Biotech, Paris, France) as an alternative treatment option for complex DRFs with a severely destroyed radial joint surface in elderly patients. The more bone-sparing Cobra implant (Groupe Lépine, Lyon, France) was presented by Herzberg in 2015 [12]. Several further studies showed moderate short-term and mid-term results (3-127 months), so that primary hemiarthroplasty is currently seen as a salvage option rather than an accepted standard [11][12][13][14][15][16][17][18][19][20].…”

“…The more bone-sparing Cobra implant (Groupe Lépine, Lyon, France) was presented by Herzberg in 2015 [12]. Several further studies showed moderate short-term and mid-term results (3-127 months), so that primary hemiarthroplasty is currently seen as a salvage option rather than an accepted standard [11][12][13][14][15][16][17][18][19][20]. However, data reporting the clinical outcome are rare.…”

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

“…It is comparable to complex wrist joint fractures; autonomous elderly patients with AO type “C 2/3” are good candidates to primary prosthetic surgery. The radial resurfing hemiarthroplasty with or without replacement of distal radius metaphysis using the Sophia (Biotech, Paris, Frankreich) implant [ 8 , 9 ], the radial component of RE-MOTION (Small Bone Innovations, Morrisville, Pennsylvania, USA) total wrist [ 10 ], the “Cobra” (Groupe Lépine, Lyon, France) implant [ 10 ], and the “Prosthelast” (Argomedical, Cham, Switzerland) implant [ 11 ] offers a useful alternative to other procedures and may help avoid secondary procedures related to posttraumatic wrist joint and DRUJ OA. Radial hemiwrist implants may also help avoid the main problem of carpal component failure in TWA.…”