Proximal row fusion as a solution for radiocarpal arthritis

Bach, Allan W.; Almquist, Edward E.; Newman, Diane M.

doi:10.1016/0363-5023(91)90008-y

Cited by 69 publications

(46 citation statements)

References 11 publications

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“…5,6,7,20,22 As all previous outcomes studies after RSL fusions have only reported postoperative motion measured in the traditional orthogonal planes, it is possible that these measurements underestimate the remaining functional capacity of these wrists. 1,3,4,8,23 We were not able to detect a change in the orientation and location of the HAM axes of the capitate for flexion/extension after pinning. However, due to the high degree of variability within the individual HAM axes associated with each position, it is premature to say that direction of motion is not altered during RSL fusion.…”

Section: Discussioncontrasting

confidence: 59%

“…The 2 largest clinical series also note that the exact posture of the fused lunate (8° flexed to 25° extended) did not affect the amount of postoperative motion. 1,4 This observation suggests that the small changes in lunate posture noted after simulated fusion should not have negatively affected our results. In our study, the lunate's posture in the pinned specimens averaged within 8° of the neutral posture of the unpinned lunate.…”

Section: Discussionmentioning

confidence: 71%

“…Second, the clinical literature regarding RSL fusion, to which we compared our results, has not included distal scaphoid excision. [1][2][3][4] Conclusions made from the data presented regarding the percentage of total wrist motion sacrificed in this simulated fusion model must be qualified. A previously published cadaver study of RSL fusions reported only the percentage of wrist motion lost after fusion.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, published clinical outcomes after RSL fusion report midcarpal arthritis in up to 50% of these patients. [1][2][3][4] This will become symptomatic in some patients and may even require conversion to a total wrist arthrodesis. Likely multifactorial in nature, the etiology of this midcarpal degeneration has not been established.…”

mentioning

confidence: 99%

“…Furthermore, none of the existing literature on RSL fusions has examined postoperative motion in any oblique plane. 1,2,3,4,8 Therefore, this cadaveric study of simulated RSL fusions was designed to define the immediate kinematic consequences of this limited wrist arthrodesis. To do this, we evaluated carpal bone motion in cadaver wrists before and after simulated RSL fusion.…”

mentioning

confidence: 99%

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Simulated Radioscapholunate Fusion Alters Carpal Kinematics While Preserving Dart-Thrower's Motion

Calfee

Leventhal

Wilkerson

et al. 2008

The Journal of Hand Surgery

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Purpose-Midcarpal degeneration is well documented after radioscapholunate fusion. This study tested the hypothesis that radioscapholunate fusion alters the kinematic behavior of the remaining lunotriquetral and midcarpal joints, with specific focus on the dart-thrower's motion.Methods-Simulated radioscapholunate fusions were performed on 6 cadaveric wrists in an anatomically neutral posture. Two 0.060-in. carbon fiber pins were placed from proximal to distal across the radiolunate and radioscaphoid joints, respectively. The wrists were passively positioned in a custom jig toward a full range of motion along the orthogonal axes as well as oblique motions, with additional intermediate positions along the dart-thrower's path. Using a computed tomography-based markerless bone registration technique, each carpal bone's three-dimensional rotation was defined as a function of wrist flexion/extension from the pinned neutral position. Kinematic data was analyzed against data collected on the same wrist prior to fixation using hierarchical linear regression analysis and paired Student's t-tests.Results-After simulated fusion, wrist motion was restricted to an average flexion-extension arc of 48°, reduced from 77°, and radial-ulnar deviation arc of 19°, reduced from 33°. The remaining motion was maximally preserved along the dart-thrower's path from radial-extension toward ulnarflexion. The simulated fusion significantly increased rotation through the scaphotrapezial joint, scaphocapitate joint, triquetrohamate joint, and lunotriquetral joint. For example, in the pinned wrist, the rotation of the hamate relative to the triquetrum increased 85%. Therefore, during every 10° of total wrist motion, the hamate rotated an average of nearly 8° relative to the triquetrum after pinning versus 4° in the normal state.Conclusions-Simulated radioscapholunate fusion altered midcarpal and lunotriquetral kinematics. The increased rotations across these remaining joints provide one potential explanation for midcarpal degeneration after radioscapholunate fusion. Additionally, this fusion model confirms the dart-thrower's hypothesis, as wrist motion after simulated radioscapholunate fusion was primarily preserved from radial-extension toward ulnar-flexion. KeywordsCadaver; fusion; lunate; radius; scaphoid Degeneration of the radiocarpal joints is the end result of interrelated traumatic, inflammatory, and metabolic processes. Intra-articular distal radius fractures, perilunate Copyright © 2008 Nevertheless, RSL fusion is not without complication. Notably, published clinical outcomes after RSL fusion report midcarpal arthritis in up to 50% of these patients. [1][2][3][4] This will become symptomatic in some patients and may even require conversion to a total wrist arthrodesis. Likely multifactorial in nature, the etiology of this midcarpal degeneration has not been established. Proposed theories explain the degeneration as a delayed effect of the initial insult or as an effect of altered joint environments resulting from the fusion....

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