Management of Complications of Wrist Arthroplasty and Wrist Fusion

Gaspar, Michael P.; Kane, Patrick M.; Shin, Eon K.

doi:10.1016/j.hcl.2015.01.004

Cited by 22 publications

(23 citation statements)

References 105 publications

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“… 19 Whether arthrodesis is total or limited to the radiocarpal or midcarpal regions, the goal is to provide relief of pain and preservation of as much function as possible, since mobility at the wrist is more important than the ability to exert force. 19 , 20 Nerve dysfunction in the aftermath of arthrodesis has been reported in 0-35% of cases, 21-36 though postoperative carpal tunnel syndrome from pressure on the median nerve may occur in 10-25%, accounting for a large proportion of these neurologic symptoms. 19 , 21 , 22 Among the studies noted, the mean incidence of nerve dysfunction was 9.7% [95% CI 7.8-12.1], with a range from 0 to 22.6%.…”

Section: Wrist Arthrodesismentioning

confidence: 99%

“… 24 During this surgical procedure, the highest neurologic risk appears to be to the dorsal sensory branch of the ulnar nerve (DSBUN) and to the sensory branch of the radial nerve (SBRN). 20 In an anatomic investigation in cadavers, Mok et al . (2006) described the course of the DSBUN, SBRN and lateral antebrachial cutaneous nerves (LABCN), over the dorsum of the wrist and hand, 25 emphasizing the importance of caution with surgical incisions in this area.…”

Section: Wrist Arthrodesismentioning

confidence: 99%

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Neurologic complications in common wrist and hand surgical procedures

Verdecchia¹,

Johnson

Baratz

et al. 2018

Orthop Rev (Pavia)

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Nerve dysfunction after upper extremity orthopedic surgery is a recognized complication, and may result from a variety of different causes. Hand and wrist surgery require incisions and retraction that necessarily border on small peripheral nerves, which may be difficult to identify and protect with absolute certainty. This article reviews the rates and ranges of reported nerve dysfunction with respect to common surgical interventions for the distal upper extremity, including wrist arthroplasty, wrist arthrodesis, wrist arthroscopy, distal radius open reduction and internal fixation, carpal tunnel release, and thumb carpometacarpal surgery. A relatively large range of neurologic complications is reported, however many of the studies cited involve relatively small numbers of patients, and only rarely are neurologic complications included as primary outcome measures. Knowledge of these neurologic outcomes should help the surgeon to better counsel patients with regard to perioperative risk, as well as provide insight into workup and management of any adverse neurologic outcomes that may arise.

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Section: Wrist Arthrodesismentioning

confidence: 99%

Section: Wrist Arthrodesismentioning

confidence: 99%

Neurologic complications in common wrist and hand surgical procedures

Verdecchia¹,

Johnson

Baratz

et al. 2018

Orthop Rev (Pavia)

View full text Add to dashboard Cite

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“…17 Although the high functional demands of the wrist may increase the susceptibility of complications for both TWA and WF patients, careful patient selection is of the utmost importance in mitigating this risk. 10 Our findings identified a relationship between patient characteristics and procedure utilization. Patients undergoing TWA were significantly older and 70% were female.…”

Section: Discussionmentioning

confidence: 62%

Total Wrist Arthroplasty Versus Wrist Fusion: Utilization and Complication Rates as Reported by ABOS Part II Candidates

Hinds

Capo

Rizzo

et al. 2016

Hand (New York, N,Y.)

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“…10 To achieve improved outcomes with TWA, additional criteria must be considered, including physical activity demands, wrist joint alignment, bone stock quality, muscle and tendon function, and precise implant positioning. 11…”

Section: Discussionmentioning

confidence: 99%

Revision Total Wrist Arthroplasty Due to Polyethylene Wear, Metallosis-Induced Carpal Tunnel Syndrome, Distal Ulnar Impingement, and Fourth Carpometacarpal Joint Pain: Case Report and Pitfalls to Avoid

Nuñez

Wright

Kilpatrick

et al. 2018

Hand (New York, N,Y.)

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Background: Total wrist arthroplasty (TWA) is indicated to alleviate pain secondary to arthritis while preserving wrist motion. Despite vigilant measures, TWAs are susceptible to complications. The current case illustrates an array of preventable complications which are addressed through operative technique in a revision setting. Case presentation: The patient was a 72-year-old man who presented with chronic pain at the fourth carpometacarpal joint (CMCJ) and distal radioulnar joint with paresthesias in the median nerve distribution. Surgery was undertaken to address the following complications secondary to a previous TWA: impingement of the native distal ulna on the prosthesis, carpal tunnel due to metallosis and polyethylene synovitis, loose carpal component, and prominent screw at the fourth CMCJ. Surgical correction included open carpal tunnel release with extensive flexor tenosynovectomy, distal ulna resection and implant arthroplasty with shortening, revision of carpal component with bone grafting, and shortening of the ulnar screw to avoid crossing the fourth CMCJ. Within 6 months of the procedure, the patient reported resolution of neuropathic symptoms and pain-free motion of the wrist. Discussion: Preventable complications associated with TWA are individually highlighted. In addition, we compare and contrast our approach and surgical technique to current reported literature. Overall, we provide education and guidance to avoid possible TWA pitfalls. Conclusion: With this case report, we hope to increase TWA knowledge with emphasis on the requirements of judicious patient selection, preoperative planning, meticulous surgical technique, and complication awareness for subsequent optimization of wrist function, stability, and durability.

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Management of Complications of Wrist Arthroplasty and Wrist Fusion

Cited by 22 publications

References 105 publications

Neurologic complications in common wrist and hand surgical procedures

Neurologic complications in common wrist and hand surgical procedures

Total Wrist Arthroplasty Versus Wrist Fusion: Utilization and Complication Rates as Reported by ABOS Part II Candidates

Revision Total Wrist Arthroplasty Due to Polyethylene Wear, Metallosis-Induced Carpal Tunnel Syndrome, Distal Ulnar Impingement, and Fourth Carpometacarpal Joint Pain: Case Report and Pitfalls to Avoid

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