Surgical techniqueRadioscapholunate Arthrodesis With Compression Screws and Local Autograft
Section snippets
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.