[Incidence and causes of failures in wrist arthroscopic techniques]

Arthroscopy represents a new and promising technique for the diagnosis and treatment of disorders of the wrist. Causes predis posing to clinical failure can arise during any phase of the approach to a patient who is a candidate for arthroscopic treatment. The author examine the causes of failure during pre-operative diagnostic workup, operative procedure and post-operative rehabilitation program and discus how to prevent them.

Three hundred fifty outpatients who had wrist arthroscopy were reviewed to determine type of procedure, type of anaesthetic, portals used and incidence and nature of preoperative, operative, and postoperative complications. Complications were divided in two groups: major and minor. The first group consists of isolated or combined vascular, nerve and/or tendon injuries, compartment syndrome joint infection and RSD, wrist rigidity. The second group includes transient superficial dorsal ulnar sensory neurapraxia, superficial portal sit infection, skin burns, tendonitis, instrumentation breaking inside the wrist joint, ganglion formation, haematomas. In a separate group othe causes of failure, especially those due to surgical or rehabilitation failures, are considered.

Ten cases of surgical and post-surgical complications (2,9%) and 8 other cases of failure considered separately (2,3%) were identified, making a total of 18 cases of clinical failure (5,1%). Among these complications 4 cases were classified as "major" [sensory nerve branch lesions of ulnar nerve (3 cases) and of radial nerve (1 case)] and 6 cases were classified as "minor" [sensory neurapraxia (3 cases), instrumentation breakage (1 case), ganglion formation (1 case), a large subcutaneous haematoma (1 case)].

Wrist arthroscopy is a sophisticated procedure, requiring dedicated surgical training and a thorough knowledge of joint disorders in order to lower the risks of complications and surgical failures.