[Damage of the wrist. Prosthetic replacement and alternatives]

Defects in the wrist and carpal bones, caused by trauma or disease, can be treated by denervation, resection-arthroplasty, arthrodesis or prosthetic replacement. In the last few years the use of the alloplasty has developed slowly in the German speaking countries. As in the American Field Clinic, surgeons should evaluate all their cases by the same criteria. Wrist: 109 prostheses were implanted by six surgeons, 51 Meuli-prostheses, one Gschwend-design and 57 Swanson-spacers. The spacer seems to be simpler and less complicated. Such complications were encountered in 40% of the prostheses, but in only one with the spacer. The scaphoid replacement, of which 227 cases are described by ten surgeons, is the most widely used in our countries. The main risk is subluxation, caused by technical errors or use of an incorrect size of spacer. The complication rate varies from seven to fourty percent. The lunate replacement--140 cases by twelve surgeons--is less common, probably because of initial failures. Correct implantation and size of the spacer are necessary for good results. Complication rate varies from 6.4 to 55 percent. A high percentage of failures is attributable to lack of operative experience. Koob is the only one who has experience with his own design "Essen". A long-term follow-up of sixteen cases shows failures in two cases, but an increase of arthrosis.