Pisotriquetral dysfunction following limited and total wrist arthrodesis.
OBJECTIVE
We report a series of pisotriquetral arthritis cases following wrist and intercarpal arthrodesis, offer an anatomic and biomechanical rationale, and introduce intraoperative considerations to avoid this potential complication.


METHODS
Nine patients with pisotriquetral arthritis requiring pisiform excision following wrist and intercarpal arthrodesis were retrospectively evaluated at 2 institutions. Five paired cadaver wrists were tested for alterations in pressure and kinematics of the pisotriquetral joint following four-corner and total wrist fusions.


RESULTS
Nine patients were successfully treated with pisiform excision for pisotriquetral arthritis following wrist and intercarpal fusions. Biomechanical cadaver testing demonstrated profound alterations in pisotriquetral kinematics and pressure changes in measured degrees of wrist position following wrist and intercarpal fusions.


CONCLUSIONS
Patients undergoing four-corner and/or wrist arthrodesis should be assessed for pisotriquetral discomfort before surgery, including a physical examination and a 30 degrees supinated radiograph to look for degenerative changes. Attempts should be made intraoperatively to ensure that the proximal row is not fused in an extended position. After surgery, if discomfort develops and conservative treatment fails, then pisiform excision can successfully alleviate the pain.
Gaston
R Glenn
RG
OrthoCarolina and Carolinas Medical Center, Charlotte, NC, USA.
Lourie
Gary M
GM
Floyd
Waldo E
WE
Swick
Matthew
M
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000503:physiopathology / Q000601:surgery; D001174:Arthrodesis / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001696:Biomechanical Phenomena; D002102:Cadaver; D050824:Carpal Joints / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D051220:Pisiform Bone / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D011312:Pressure; D011859:Radiography; D012189:Retrospective Studies; D051221:Triquetrum Bone / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*