[Arthrodesis of the wrist. Indication, technique and functional consequences for the hand and wrist].
Three studies conducted in our center demonstrated an improved technical success rate and elimination of preoperative pain in patients undergoing wrist fusions, with no significant difference in the ability to perform rapid movements requiring manual dexterity in the course of activities of daily living compared with patients who had undergone motion-preserving limited arthrodeses. The only absolute drawback of wrist fusion is that it obviously does not allow for any wrist motion at all. Limited intercarpal arthrodesis preserves some motion, but according to our results never leads to increased motion postoperatively. Several specific skills were found to present difficulty in patients who had undergone total wrist fusion. These included those requiring volar flexion in a limited space, where it would be difficult to have recourse to compensatory motion imparted by the shoulder and elbow, and those requiring forceful pronation and supination with simultaneous strong grasping. For patients involved in certain occupations requiring fine manual dexterity in tight spaces, wrist fusion might not be the most appropriate procedure. It is interesting that there appears to be a learning curve to the patient's ability to undertake specific activities postoperatively. A strong practice effect is present for the first 3-6 postoperative months, during which time a significant improvement in the patient's overall function is noted. Total wrist arthrodesis gives highly predictable results in the treatment of wrist pain and instability. The ability to perform normal activities of daily living and strenuous manual tasks was comparable to that after alternative motion-preserving procedures. We have not observed improved wrist motion after any wrist motion-preserving procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Hastings
H
H
Indiana University School of Medicine, Indiana Hand Center, Indianapolis.
Weiss
A P
AP
Strickland
J W
JW
D000203:Activities of Daily Living; D001174:Arthrodesis / Q000379:methods* / Q000534:rehabilitation; D002348:Carpal Bones / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000601:surgery; D009068:Movement; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D014955:Wrist Joint / Q000502:physiology / Q000601:surgery*