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[Midcarpal partial arthrodesis with locking plate osteosynthesis]
J-F Hernekamp1, U Kneser2, T Kremer2
1Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie - Schwerbrandverletztenzentrum, BG‑Unfallklinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland. Frederick.Hernekamp@pgdiakonie.de.
Operative Orthopadie Und Traumatologie
|August 10, 2017
Summary
This study demonstrates a surgical technique for advanced carpal collapse, achieving bone consolidation and preserving wrist mobility. Patients experienced significant pain reduction and improved grip strength post-operation.
Area of Science:
- Orthopedic Surgery
- Hand and Wrist Surgery
- Musculoskeletal Research
Background:
- Advanced carpal collapse, including scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC), presents significant challenges in preserving wrist function.
- Osteoarthritis affecting the radiocarpal and intercarpal joints necessitates effective surgical interventions to manage pain and maintain mobility.
Purpose of the Study:
- To evaluate a surgical technique aimed at preserving residual wrist mobility and reducing pain in patients with advanced carpal collapse (SLAC/SNAC stages 2-3).
- To assess the efficacy of scaphoid resection, chondrolysis, and bone grafting with internal fixation in treating severe wrist osteoarthritis.
Main Methods:
- A dorsal longitudinal incision was utilized, exposing the wrist capsule via a radial capsular flap.
- Scaphoid resection was performed, followed by chondrolysis of the capitate-lunate and hamate-triquetral articulations.
- Radial cancellous bone grafting, lunate repositioning, and plate fixation were employed, with postoperative immobilization and physiotherapy.
Main Results:
- Complete bone consolidation was achieved in all 11 patients within 12 weeks postoperatively, with no implant-related complications.
- Satisfactory functional outcomes included preserved wrist mobility (53° extension-flexion, 30° radial-ulnar abduction) and grip strength (56% of the contralateral side).
- Significant pain reduction was reported (VAS 0.7 at rest, 4.3 under load), with a mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 33.
Conclusions:
- The described surgical technique effectively addresses advanced carpal collapse by promoting bone consolidation and improving wrist function.
- This approach offers a viable solution for pain management and preservation of residual mobility in severe wrist osteoarthritis.
- Further research may explore long-term outcomes and refine surgical protocols for optimal patient results.
