A comparison of dart thrower’s range of motion following radioscapholunate fusion, four-corner fusion and proximal row carpectomy

Abstract

Dart thrower's motion is the functional coupled movement of the wrist from radial extension to ulnar flexion. The aim of this study was to evaluate dart thrower's motion following three surgeries: radioscapholunate fusion, four-corner fusion and proximal row carpectomy. Six fresh-frozen cadaver forearms were dissected. Sequential loading of tendons resulted in radial extension and ulnar flexion allowing dart thrower's motion measurements at end range before and then again after each surgery. After radioscapholunate fusion, 74% of both radial extension and ulnar flexion were maintained. After four-corner fusion, radial extension decreased to 53% and ulnar flexion to 84% of control motion. Proximal row carpectomy did not statistically significantly alter radial extension, but decreased ulnar flexion to 87%. We found that dart thrower's motion is well maintained in three of these commonly used surgical treatments. These results may aid surgeons in managing patients by providing comparative functional movement following these procedures.

In-vivo three-dimensional motion analysis of the wrist during dart-throwing motion after midcarpal fusion and radioscapholunate fusion

“…In contrast, we found that the patients after RSL fusion had significantly reduced ROM during DTM compared with the patients after MF. Our findings are supported by two cadaver studies, which found no significant differences in the DTM after RSL and MF (Kane et al., 2018; Rust et al., 2018). Kane et al.…”

“…Partial wrist fusion is frequently carried out with the aim of reducing pain at the radiocarpal and midcarpal joints and maintaining the best possible wrist function. However, previous studies investigating the effect of simulated partial wrist fusions on DTM have been done only on cadavers (Calfee et al., 2008; Kane et al., 2018; Rust et al., 2018). The effects of limited mobility on wrist kinematics during functional movements have not yet been investigated in vivo.…”

The effect of surgery for basal osteoarthritis of the thumb on dart thrower’s motion

“…Three individual Kessler sutures of 3-0 Prolene (Ethicon®, Somerville, NJ, USA) were stitched into each tendon, to grasp the tendon ends. A specially designed frame (Rust et al., 2018) was used. The specimens were fixed by the clamp on the radius, orienting the specimens vertically, with the fingers dependant and ensuring that the wrist was hanging freely, thus removing the effects of gravity.…”

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

“…Moreover, these biomechanics declare as well that after PWF the wrist is compromised due to the increased compressive forces in the surrounding intercarpal joints which is to be considered generally as a predisposition for secondary OA [22]. Furthermore, due to the coupled motion between extension-flexion and radial-ulnar deviation [23], impaired wrist extension-flexion inevitably can lead to impairment of "dart-throwing" motion [24], but it is not always observed after radiocarpal fusion, 4CF, and PRC [25]. PRC (i.e.…”