Lunotriquetral arthrodesis. A controversial procedure.
12 male (mean age 28) and 11 female (mean age 32) patients treated with lunotriquetral (LT) arthrodesis were reviewed with a median follow-up of 28 months (range 18-40 months) for this retrospective study. At first presentation 12 patients were unable to work, and at follow-up only three men remained out of work. The relief of pain was significant (P < 0.001) and the median Culp (1993) wrist score obtained 74 (min. 45, max. 96); however, only one patient was totally free of pain and seven men had to change their occupations. Men lost 455 working days, women 191, a highly significant difference (P = 0.006). This loss correlated (P = 0.007) with the LT angle measured in the frontal plane: all patients but one with a LT angle of less than 31 degrees returned to work within 1 year, but only four with a greater angle (P = 0.007). This emphasizes the importance of correct positioning of the triquetrum, which seems hard to achieve with two AO lag screws. Furthermore, even two screws seem unable to ensure solid fusion as shown by the high rate of pseudarthrosis (57%). LT fusion cannot be considered as a routine procedure and results are not yet predictable. According to these results, we feel that a bone graft placed in a slot from lunate to triquetrum is the procedure of choice. In the presence of a chondromalacia in the ulnar midcarpal joint, a four bone fusion is primarily recommended.
Sennwald
G R
GR
Chirurgie St Leonhard, St Gallen, Switzerland.
Fischer
M
M
Mondi
P
P
D000328:Adult; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D016025:Bone Transplantation; D002348:Carpal Bones / Q000503:physiopathology / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*