Ulnocarpal abutment after wrist arthrodesis

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Musculoskeletal Conditions

Background:

• Wrist arthrodesis is a surgical procedure to fuse the wrist joint, often performed for severe arthritis or instability.
• Complications following wrist arthrodesis can include persistent pain and limited function, necessitating further intervention.
• Ulnocarpal abutment is a potential, though less common, complication that can arise after wrist fusion.

Observation:

• Three patients (aged 22-34) presented with ulnar wrist pain and restricted forearm rotation post-wrist arthrodesis.
• The underlying reasons for initial wrist arthrodesis included degenerative arthritis and silicone synovitis secondary to Kienböck's disease, or post-traumatic arthritis.
• All arthrodeses were performed using an A.O. plate and iliac crest bone graft.

Findings:

• Surgical intervention involving excision of either the triquetrum (two patients) or the pisiform (one patient) successfully alleviated ulnar-sided wrist pain.
• Forearm rotation was improved in one patient and not compromised in any of the three patients following carpal bone excision.
• The average follow-up period was 16 months, indicating sustained relief from symptoms.

Implications:

• Carpal bone excision is a viable treatment option for managing ulnocarpal abutment and associated pain after wrist arthrodesis.
• This surgical approach can restore or maintain forearm rotation, improving overall wrist function post-fusion.
• Further investigation into the incidence and management of ulnocarpal abutment following wrist arthrodesis is warranted.