Surgical technique
Radioscapholunate Arthrodesis With Compression Screws and Local Autograft

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Radioscapholunate arthrodesis is performed for patients who experience pain and disability from radiocarpal arthritis. Initial reports from the 1980s demonstrated high nonunion rates and marginal clinical outcomes. Improvements in surgical technique and clearly defined indications have reduced nonunion rates and improved patient satisfaction. We present a technique using headless compression screws inserted through a dorsal approach, which optimizes hardware placement and incorporates local bone graft harvested from the insertion site to supplement the arthrodesis.

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Surgical Technique

The patient is positioned supine with the upper extremity placed on an arm board and a nonsterile tourniquet applied to the upper arm. A regional block is preferentially used for anesthesia. The wrist is exposed through a dorsal approach using an incision in line with the third metacarpal extending from the capitate to 2 cm proximal to Lister tubercle (Fig. 1). The exposure should allow for sufficient access to the metaphysis of the distal radius to create a cavity for optimal screw placement.

Postoperative Care

The patient is placed in a short-arm cast or splint at the first postoperative visit. Range of motion is encouraged in the digits and occupational therapy is prescribed as needed. Subsequent evaluations are usually performed at 4-week intervals until there is radiographic evidence of fusion (Fig. 10). This typically occurs between 6 and 12 weeks. The fusion can be further evaluated and confirmed with a computed tomography scan. After confirmation of successful fusion, immobilization is

Results

Between August 2010 and October 2011, we identified 9 patients who underwent RSL arthrodesis performed by the senior authors (M.S.C. and J.J.F.) for degenerative joint disease isolated to the radiocarpal articulation using the surgical technique described here. The primary diagnoses were posttraumatic arthritis (7 patients), primary osteoarthritis (1 patient), and rheumatoid arthritis (1 patient). The average age at the time of arthrodesis was 43 years (range, 26–58 y). There were no

Discussion

Isolated degeneration of the radiocarpal joint may occur posttraumatically and can be associated with both noninflammatory and inflammatory arthropathies. Over the past several decades, RSL arthrodesis has been validated as a motion-preserving surgical treatment for this condition. Innovations in surgical technique and implant design have improved the efficacy and outcomes of RSL arthrodesis.1, 4, 5, 7

Several studies have demonstrated superior biomechanical performance of cannulated compression

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R.W.W. is a consultant for Acumed.

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