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Lunate migration following Darrach's procedure: a case report.
1Department of Orthopaedics, Southend General Hospital, Prittlewell Chase, United Kingdom. ortho@houseofjoy2000.freeserve.co.uk
Journal of Orthopaedic Surgery (Hong Kong)
|December 17, 2003
Summary
Darrach's procedure for rheumatoid wrist disease can lead to severe complications like carpal instability. A total wrist arthrodesis successfully treated a patient experiencing post-operative wrist pain and collapse.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Hand Surgery
Background:
- Darrach's procedure addresses distal radioulnar joint derangement, often caused by rheumatoid arthritis.
- Rheumatoid disease can lead to significant wrist joint pathology and instability.
Observation:
- A 28-year-old female with rheumatoid disease underwent Darrach's procedure on her dominant wrist.
- Four weeks post-surgery, she experienced severe wrist pain, scaphoid collapse, and proximal lunate migration.
Findings:
- The patient's symptoms were successfully managed with a total wrist arthrodesis using an Arbeitsgemeinschaft für Osteosynthesefragen (AO) wrist arthrodesis plate.
- This case demonstrates a severe complication of Darrach's procedure, particularly in the presence of pre-existing ligamentous instability.
Implications:
- Darrach's procedure, while effective for certain conditions, carries a risk of iatrogenic instability.
- Careful patient selection, considering pre-existing ligamentous integrity, is crucial before performing Darrach's procedure.
- Total wrist arthrodesis serves as a viable salvage procedure for managing severe complications following Darrach's procedure.