[Capitolunate arthrodesis with tension band wire in wrist arthritis: twenty cases with four year follow-up].
OBJECTIVE
Treatment of degenerative osteoarthritis of the wrist is aimed at preserving wrist motion and force while reducing pain. Limitation of the degenerative processes to certain joints raises the possibility of intracarpal arthrodesis, e.g. capitolunate arthrodesis. We present results of this procedure with a tension band wire in patients with arthritic degenerative disease of the wrist.


METHODS
The series included 20 patients reviewed at mean 47 months. Mean age was 53.5 years. Pain was the main complaint. Wrist force and motion were decreased in all patients. All patients presented osteoarthritic disease of the wrist with preservation of the radiolunate space. The operation consisted in total scaphoidectomy and capitolunate arthrodesis maintained with a tension band wire. Force, pain (Mayo clinic score) and force (Jamar dynamometer) were recorded. The Cooney function score was determined and six patients completed the French Dash questionnaire. Radiolunate and capitolunate angles were noted as well as the index of carpal height measured preoperatively and at last follow-up.


RESULTS
Nineteen of the 20 arthrodeses fused. A revision graft was successful for the one nonunion. Pain was the only clinical factor which improved significantly (p<0.0001) in all patients. Lunatum extension (DISI) and capitatum flexion did not have any effect on functional outcome. Sixteen patients resumed their activities at the same level.


CONCLUSIONS
The results of this series are similar to those in the literature concerning four-way arthrodesis. Capitatolunate arthrodesis with partial arthrodesis of the carpus has been proposed for arthritic degeneration of the wrist with a preserved radiolunate space. We prefer this procedure to four-way arthrodesis because useful motion and wrist force are preserved with constant and effective significant pain relief.
Durand
A
A
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims. alexandre.durand@wanadoo.fr
Harisboure
A
A
Nurbel
B
B
Lawane
M
M
Grenier de Cardenal
D
D
Giraud
B
B
Kassouma
J
J
Dehoux
E
E
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001696:Biomechanical Phenomena; D001864:Bone Wires; D051224:Capitate Bone / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010146:Pain / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000601:surgery; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery*