Lunotriquetral arthrodesis, a procedure with a high failure rate

The authors retrospectively reviewed 29 patients with chronic lunotriquetral ligament tears who were treated with lunotriquentral arthrodesis. Arthrography confirmed the diagnosis in 17 cases, arthroscopy in 18. Associated lesions included 13 TFCC tears and 8 scapholunate ligament tears. The fusion was carried out with staples in 5 cases, a Herbert screw in 17, a Kirschner wire in 6. Bone grafts were used in 24 cases. In 15 cases additional procedures were performed. As for the subjective outcome, 5 patients were fully satisfied, 10 had reservations and 14 were not satisfied; 17 patients would repeat the procedure. The average Pellenberg wrist score for pain and function was 59/80 (0 no symptoms, 80 maximal pain). Mean grip force was 69% of the contralateral side and lateral pinch force was 79%. Flexion loss averaged 24 degrees, and extension loss 21 degrees. Fusion was achieved in 16 cases; nonunion persisted in 13. Twelve important complications were noted. In 17 cases the wrist remained painful; in 19 patients an average of two additional surgical procedures were required. Fusion was obtained in two of seven revision cases; five remained painful. Three patients went on to complete wrist arthrodesis. In the light of these results the effectiveness of this procedure has to be reconsidered compared to other alternatives, such as ligamentoplasty and extended arthrodesis (4 corner).