Considerations in Correction of Wrist Deformity in Arthrogryposis

The wrist is affected in all the forms of arthrogryposis and is a common site requiring surgical intervention. The wrist usually has a flexion and ulnar deviation deformity of varying severity. A flexion deformity of >40° results in a weak hand grip and gives an 'abnormal' look to the patient as a whole and hence, is a common reason for patients to desire surgical correction. However, as children tend to adjust to whatever posture they have as they grow, the most important thing a surgeon should be aware of, is when and whom not to operate. This article discusses all these possibilities in detail and provides authors preferred surgical plan. We have found a combination of volar fascia release, intercarpal wedge resection osteotomy and extensor carpi ulnaris to extensor carpi radialis brevis tendon transfer to be most effective and reliable. Patient and parental satisfaction with early surgical intervention is often satisfactory. Level of Evidence: Level V (Therapeutic).