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Triquetrohamate arthrodesis for midcarpal instability

S B Rao1, J E Culver

  • 1Department of Orthopaedic Surgery, Cleveland Clinic Foundation, OH 44195, USA.

The Journal of Hand Surgery
|July 1, 1995
PubMed
Summary

Triquetrohamate arthrodesis for midcarpal instability yielded mixed results, with nearly half of patients experiencing persistent symptoms despite improved joint stability. This surgical intervention for wrist pain requires careful consideration due to its variable outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Hand and Wrist Surgery
  • Biomechanics

Background:

  • Midcarpal instability often presents as ulnar-sided wrist pain and can be diagnosed through physical examination and cineradiography.
  • Surgical intervention is considered when conservative treatments and soft tissue reconstruction fail to alleviate symptoms.

Purpose of the Study:

  • To evaluate the efficacy of triquetrohamate arthrodesis in managing symptomatic midcarpal instability.
  • To assess the functional outcomes and patient satisfaction following this surgical procedure.

Main Methods:

  • Retrospective review of 10 patients (11 wrists) who underwent triquetrohamate arthrodesis for midcarpal instability.
  • Diagnosis confirmed by ulnar-sided wrist pain, specific joint tenderness, and characteristic cineradiographic findings during specific wrist maneuvers.

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  • Follow-up averaged 26 months, assessing range of motion, grip strength, and overall symptom control.

    • Main Results:

    • Two excellent, four good, three fair, and two poor outcomes were reported.
    • Post-surgery, average range of motion was 55-64% of the contralateral side, and grip strength averaged 64%.
    • Triquetrohamate arthrodesis failed to adequately control symptoms in nearly 50% of the cases, indicating limited effectiveness.

    Conclusions:

    • While triquetrohamate arthrodesis can provide midcarpal joint stability, it does not consistently resolve symptoms of midcarpal instability.
    • The procedure demonstrates variable patient outcomes, with a significant portion experiencing persistent pain and functional limitations.
    • Further research may be needed to identify optimal surgical candidates and refine techniques for managing midcarpal instability.