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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2002, Number 3

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Acta Ortop Mex 2002; 16 (3)

Functional results of carpal segmental arthrodesis in patients who have carpal navicular pseudoarthrosis or Kienböck’s disease

Arenas ZMV, Marín ED

Language: Spanish
References: 20
Page: 145-149
PDF size: 43.87 Kb.


ABSTRACT

Objective. Intra-carpal segmental arthrodesis in those patients who have either nechrosis of the lunate bone or carpal navicular non-union, in whom arthrosis of the wrist can be expected, has the objective to avoid the extreme limitation usually produced by complete arthrodesis of the wrist joint. Materials and methods. From January 1997 to December 1999, a series of 15 patients who had navicular pseudoarthrosis in 8 (all male) and Kienböck’s disease in 7 (5 male and 2 female), were treated by partial mid-carpal arthrodesis between the bones navicular-capitate-lunate. All cases had a grade III to IV of arthrosis. Dorsal approach was performed in 14 cases and a double approach in the remaining one. Arthrodesis was reinforced by autologous bone grafting and temporarily fixed by 1.6 mm Kirschner wires and a palmar splint. Results. Bone union of the arthrodesis was achieved in an average of 8.5 weeks, after that, wires were removed. In the cases of the scaphoid, pain disappeared in 4, was mild in 3 and moderate in 1. In the cases of Kienböck’s, 3 were pain free, it was mild in 2 and moderate in 2. No case had severe pain after surgery. Arthrosis improved in all but in one case of Kienböck’s (p=0.05). Range of motion was functional in all (p=0.01); 11 patients (70%) were free of pain as final result. Conclusion. Segmental mid-carpal arthrodesis which is one of the 27 surgical methods that we have found out for treatment of carpal arthrosis, has demonstrated to be an excellent procedure for the functional treatment of chronic damage of the most commonly injured carpal bones such as navicular and lunate.


REFERENCES

  1. Brown DE, Neumann RD. Orthopedic secrets. Mosby 1995: 164.

  2. Fortin PT, Louis DS. Long-term follow-up of scaphoid-trapezium-trapezoid arthrodesis. J Hand Surg 1993; 18(a): 675-81.

  3. García J. Uso de la artrodesis segmentaria del carpo en la inestabilidad carpal. Tesis de postgrado, 1992.

  4. Gilula LA, Weeks PM. Post-traumatic ligamentous instabilities of the wrist. Diagn Radiol 1978; 129: 641-51.

  5. Green D. Operative hand surgery, Churchill Livingstone 1999: 865-928.

  6. Hasting DE, Silver RL. Intercarpal arthrodesis in the management of the chronic carpal instability after trauma. J Hand Surg 1984; 9: 834-40.

  7. Kapandji IA. Cuadernos de fisiología articular. 4a ed. Editorial Toray Masson 1982: 138-171.

  8. Kirschenbaum D, Schneider IH, et al. Scaphoid excision and capittolunate arthrodesis for radioscaphoid arthritis. J Hand Surg 1993; 18: 780-85.

  9. Larsen CF, Jacoby RA, Mccabe SJ. Nonunion rate of limited carpal arthrodesis: a meta-analysis of the literature. J Hand Surg 1997; 22: 66-73.

  10. Linscheid RL, Dobyns JH, Beaubout JW, Bryan RS. Traumatic instability of the wrist, diagnosis, classification and pathomechanics. J Bone Joint Surg 1972; 54A: 1612-32.

  11. Mih AD. Limited wrist arthrodesis. Hand Clin 1997; 13(4): 615-2.

  12. Minami A, Kato H, Iwasaky N, Minami M. Limited wrist fusion: comparison of result 22 and 89 months after surgery. J Hand Surg 1999; 24: 133-37.

  13. Netter FH. Sistema músculo esquelético 4a ed. 1994, tomo III: 66-8.

  14. Osamu I, Tsu-Min Tsai. Complications and results of scapho-trapezio-trapezoid arthrodesis. Clin Orthop 1993; 287: 125-30.

  15. Pisano SM, Peimer CA, Wheeler DR, Sherwin F. Scaphocapitate intercarpal arthrodesis. J Hand Surg 1991; 16: 328-33.

  16. Ritt MJ, Linscheid RL, Cooney WP, Berger RA, An KN. The lunotriquetal joint: kinematic sequential ligament sectioning, ligament repair and arthrodesis. J Hand Surg 1999; 23: 432-45.

  17. Rotman MB, Manske PR, Pruitt DI, Szerzinski J. Scaphocapitolunate arthrodesis. J Hand Surg 1996; 4: 245-49.

  18. Taleisnik J. The Wrist. Churchill Livingstone. 1985; 111: 13-39.

  19. Taleisnik J. Post-traumatic carpal instability. Clin Orthop 1980; 149: 73-82.

  20. Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg 1995; 20(6): 965-70.




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