Assessment of Wrist Function After Simulated Total Wrist Arthrodesis

Hinds, Richard M.; Melamed, Eitan; O’Connell, April; Cherry, Francoise; Seu, Monica; Capo, John T.

doi:10.1177/1558944715626930

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…3A-B). Yuvaraj et al [33] showed improved grip strength with ulnar deviation, but other studies on grip strength after wrist fusion have suggested that positioning the wrist in extension offers better strength; however, these studies did not demonstrate any benefit of ulnar deviation [6,8]. Therefore, in our study, we maintained wrist dorsiflexion at 10°to 15°as before, which was consistent with the most functional position after fusion in previous reports [10,18] (Fig.…”

Section: Introductionsupporting

confidence: 89%

“…Some loss of grip strength is expected with a wrist fusion when compared with the normal side. In addition to reports supporting wrist dorsiflexion [3, 6, 8, 11-13], we reasoned that grip strength could be slightly improved by further radializing the translocated ulna and aligning it with the second metacarpal joint to achieve ulnar deviation, as demonstrated by Yuvaraj et al [33]. The loss of grip strength from using the second metacarpal was less than the outcomes reported by Vyas et al [29] and Qu et al [21] (loss of 29% grip strength in operated limb).…”

Section: Discussionmentioning

confidence: 84%

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Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?

Gundavda

Agarwal

Reddy

et al. 2021

Clin Orthop Relat Res

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Background Ten years ago, we reported the results of a procedure in which we translocated the ipsilateral ulna as a vascularized autograft to reconstruct defects of the distal radius after tumor resection, with excellent functional results. At that time, wrist arthrodesis was achieved by aligning the translocated ulna with the scapholunate area of the carpus and usually the third metacarpal. This resulted in wrist narrowing. We then wondered if aligning the translocated ulna with the scaphoid and the second metacarpal would result in ulnar deviation and thereby improve grip strength. We believed lateralization would reduce the wrist narrowing that occurs with fusion to the third metacarpal and would make the cosmesis more acceptable. We also modified the incision to dororadial to make the scar less visible and thus improve the cosmesis. Questions/purposes (1) Is there an objective improvement in grip strength and functional scores (Musculoskeletal Tumor Society [MSTS] and Mayo wrist) when the translocated ulna is lateralized and the wrist is fused with the translocated ulna and aligned with the second metacarpal versus when the translocated ulna is aligned with the third metacarpal? (2) Did lateralization caused by the wrist fusion aligned with the second metacarpal minimize wrist narrowing as measured by the circumference compared with the fusion aligned with the third metacarpal? Methods From 2010 and 2018, we treated 40 patients with distal radius tumors at our institution, 30 of whom had a distal radius enbloc resection. Twenty-eight patients had an ipsilateral ulna translocation and wrist arthrodesis in which the radius and translocated ulna were aligned with either the second (n = 15) or the third (n = 13) metacarpals. Two patients in the second metacarpal group and three patients in the third metacarpal group were lost to follow-up before 24 months after surgery and were excluded. A retrospective analysis of 23 patients (20 with giant cell tumors and three with malignant bone tumors) included a review of radiographs and institutional tumor database for surgical and follow-up records to study oncologic (local disease recurrence), reconstruction (union of osteotomy junctions, implant breakage or graft fracture, and wrist circumference), and functional outcomes (MSTS and Mayo wrist scores and objective grip strength assessment compared with the contralateral side). The results were compared for each study group (second metacarpal versus third metacarpal). There was no difference in the incidence of local recurrence or the time to union between the two groups. There were no implant breakages or graft fractures noted in either group. Results Patients in the second metacarpal group lost less grip strength compared with the unoperated side in the third metacarpal group (median 12% [range -30% to 35%] versus median 28% [15% to 42%], difference of medians 16%; p = 0.006). There were no between-group differences in terms of MSTS (median 30 [24 to 30] versus median 26.5 [22 to 30], difference of medians 3.5; p = 0.21) or Mayo wrist scores (median 83 [65 to 100] versus median 72 [50 to 90], difference of medians 11; p = 0.10). The second metacarpal group also had less wrist narrowing as seen from the median difference in circumference between the operated and unoperated wrists (median narrowing 10 mm [3 to 35 mm] in the second metacarpal group versus median 30 mm [15 to 35 mm] in the third metacarpal group, difference of medians 20 mm; p = 0.04). Conclusion Wrist arthrodesis after ulna translocation with alignment of the translocated ulna and the second metacarpal provides a functional position with ulnar deviation that offers some improvement in grip strength but no improvement in the MSTS or Mayo scores. Radialization/lateralization of the translocated ulna achieved from the alignment with the second metacarpal decreases the reduction in the wrist circumference and therefore reduces wrist narrowing. Level of Evidence Level III, therapeutic study.

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Section: Introductionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 84%

Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?

Gundavda

Agarwal

Reddy

et al. 2021

Clin Orthop Relat Res

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“…15 On the contrary, Hinds et al said that the position of fusion did not affect the grip strength or satisfaction. 11 In our case, the position of the wrist could be changed by different degrees by bending the K wires after they had been introduced into the bone (Fig. 3).…”

Section: Discussionmentioning

confidence: 88%

“…Some authors have advocated arthrodesis without a bone graft, [1][2][3] whereas others recommended the bone graft. [4][5][6][7] Various fixation devices have also been reported, including K wires or Steinmann pins, 4,7-10 staples, 1 screws, 11 and compression plates. 7,12 However, the rate of successful fusion and the incidence of complications have varied greatly.…”

Section: Introductionmentioning

confidence: 99%

Wrist Arthrodesis in Rheumatoid Arthritis by Parallel K Wires and Ulna Autograft: A Case Report

Muthu¹,

Hemanthakumar²,

Muthalagan³

2020

Journal of Orthopedics and Joint Surgery

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Case description Nowadays, management of end-stage rheumatoid wrist remains controversial between fusion and arthroplasty. We present a simple method of rheumatoid wrist fusion in a 56-year-old woman, using parallel Kirschner (K) wires and local ulna graft. Wrist fusion was achieved at 8 weeks, while implants are removed a month later without any complications in the immediate or late postoperative period. Conclusion Management of end-stage rheumatoid wrist with parallel wires remains a simple, versatile, and reliable method to achieve wrist fusion without any complication due to hardware or the disease by itself. How to cite this article Hemanthakumar G, Sathish M, Muthalagan N. Wrist Arthrodesis in Rheumatoid Arthritis by Parallel K Wires and Ulna Autograft: A Case Report. J Orth Joint Surg 2020;2(1):38–40.

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“…However, Larsson noted that a little extension and ulnar deviation boosted grip power [ 29 ]. On the other hand, the fusion posture did not influence grip strength or contentment, according to Hinds et al [ 30 ]. Our study’s average postoperative hand position of patients following wrist arthrodesis was 17.5 degrees of extension and 6 degrees of ulnar deviation.…”

Section: Discussionmentioning

confidence: 90%

Wrist Arthrodesis Using a Trapezoidal Wedge Graft from the Distal Radius and a Low-Profile Reconstruction Plate

Bhat

Acharya

et al. 2023

JOIO

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Background Various intramedullary or dorsally based fusions have been utilised to perform wrist arthrodesis. Although the dorsal plate is rigid and well constructed, the standard of care was replenishing the arthrodesis site with an iliac crest bone graft. Due to the high morbidity of the donor site, alternatives such as distal radius bone grafts have gained popularity. In this study, wrist arthrodesis was performed with a locally accessible trapezoidal wedge graft from the distal radius and a low-profile reconstruction plate to evaluate the radiological and functional outcome. Methods We retrospectively reviewed 22 wrists, 14 brachial plexus injuries, 4 post-traumatic injuries, and 4 rheumatoid arthritis patients, with a mean follow-up of 31 months. Union was evaluated on radiography. The functional outcomes were evaluated using a visual analog scale incorporated into a questionnaire. Results All 22 fusions united successfully, with a mean duration of 12 weeks and a wrist position of an average 17.5 degrees of extension and 6 degrees of ulnar deviation. The aesthetics of the wrist showed the most significant change, and overall satisfaction levels increased. Conclusions A locally accessible cortico-cancellous graft from the dorsum of the radius is a reliable alternative to an iliac crest or carpal bone graft with high potential for the union. It also serves as a stable strut in our construct, allowing us to use a low-profile reconstruction plate. The Reconstruction (3.5 System) plate can be used safely with excellent results and a low implant prominence or breakage risk.

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Assessment of Wrist Function After Simulated Total Wrist Arthrodesis

Cited by 4 publications

References 19 publications

Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?

Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?

Wrist Arthrodesis in Rheumatoid Arthritis by Parallel K Wires and Ulna Autograft: A Case Report

Wrist Arthrodesis Using a Trapezoidal Wedge Graft from the Distal Radius and a Low-Profile Reconstruction Plate

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