title: Dorsal carpal wedge osteotomy in the arthrogrypotic wrist.
abstract: OBJECTIVE
  To assess the outcome of patients who underwent dorsal carpal wedge osteotomy (DCWO) for the treatment of wrist flexion deformities causing functional limitations resulting from arthrogryposis.
  
  
  METHODS
  We performed a retrospective chart review of consecutive patients treated with DCWO between 1996 and 2009 by a single surgeon. Follow-up of greater than 1 year (mean, 45 mo; range, 12-108 mo) was available in 12 patients (20 wrists).
  
  
  RESULTS
  All 12 patients' parents reported subjective improvement in position and appearance, and in performing activities of daily living. Wrist extension was significantly increased (mean, 43°), wrist flexion was significantly decreased (mean, 34° from neutral), and there was no significant change in wrist motion arc. We saw significantly greater improvement in wrist extension in children operated on at 7 years of age or greater and in patients treated concomitantly with an extensor carpi ulnaris tendon transfer. Complications included 1 infection.
  
  
  CONCLUSIONS
  The excessively flexed wrist in children with arthrogryposis can safely and effectively be improved with DCWO, which in turn facilitates independence in activities of daily living and school-related tasks as reported by parents. For patients older than 7 years of age at the time of surgery, and for patients treated with concomitant extensor carpi ulnaris transfer at the time of DCWO, we found greater recovery of wrist extension.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55454, USA. vanhe003@umn.edu
authors.forename: Ann E
authors.initials: AE
authors.lastname: Van Heest
authors.forename: Rudy
authors.initials: R
authors.lastname: Rodriguez
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D001176:Arthrogryposis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006236:Handwriting; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013709:Tendon Transfer; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*