Long-term results after midcarpal arthrodesis.

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Musculoskeletal Research

Background:

• Advanced carpal collapse necessitates effective surgical interventions.
• Midcarpal arthrodesis is a recognized treatment for this condition.
• Long-term outcomes and complication profiles require thorough evaluation.

Purpose of the Study:

• To retrospectively assess the survival and complication rates of midcarpal fusion.
• To review long-term clinical and radiological follow-up data.
• To evaluate functional outcomes and patient-reported pain levels.

Main Methods:

• Retrospective analysis of 594 four-corner fusions in 572 patients (1992-2001).
• Randomized clinical and radiological follow-up for 60 midcarpal fusions in 56 patients at a mean of 14.7 years.
• Assessment of Disabilities of the Arm, Shoulder, and Hand (DASH) scores and visual analog scale (VAS) for pain.

Main Results:

• 40 fusions (6.7%) required conversion to complete wrist arthrodesis due to pain or nonunion.
• 11% of patients needed revision surgery for nonunion, hematoma, infection, or persistent pain.
• Mean DASH score was 20.4; mean VAS pain score was 3.3.
• Functional outcomes included significant wrist motion and grip strength preservation compared to the unaffected side.
• Radiographic abnormalities, including osteoarthritis, were common; preserved carpal height correlated with better outcomes.

Conclusions:

• Midcarpal arthrodesis is a durable treatment for advanced carpal collapse with favorable long-term results.
• While effective, potential complications like nonunion and persistent pain necessitate careful patient selection and management.
• Preservation of carpal height appears to be a significant factor in achieving optimal functional outcomes post-surgery.