Download PDF
J Wrist Surg 2012; 01(02): 103-114
DOI: 10.1055/s-0032-1329548
Special Focus Section: Motion Preserving Procedures of the Wrist
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Decision Making for Partial Carpal Fusions

Gregory Ian Bain
1   Department of Orthopedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia
2   Discipline of Anatomy and Pathology, University of Adelaide, Adelaide, South Australia, Australia
3   Department of Orthopedics and Trauma, Modbury Public Hospital, Adelaide, South Australia, Australia
4   Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
,
Duncan Thomas McGuire
3   Department of Orthopedics and Trauma, Modbury Public Hospital, Adelaide, South Australia, Australia
4   Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
19 December 2012 (online)

    Permissions and Reprints

Abstract

Limited wrist fusions are effective surgical procedures for providing pain relief while preserving motion of the wrist in patients with localized arthritis of the carpus. In deciding which motion-preserving procedure to perform, the etiology of the arthritis, which joints are involved, and which are spared should be determined. The main principle is to fuse the involved joints and to allow motion through the uninvolved joints. In this article, we discuss the various traumatic and nontraumatic conditions causing arthritis of the wrist and the treatment options for those conditions. Common indications for limited wrist fusions include scapholunate advanced collapse and scaphoid nonunion advanced collapse. Options for treating these conditions include three- and four-corner fusions as well as a proximal row carpectomy. This paper discusses which procedures are the most appropriate as well as the outcomes of these procedures. If the basic principles of limited wrist fusions are adhered to, a good outcome can be obtained. The authors' surgical technique and decision-making processes are discussed.

Keywords

carpal fusion - wrist salvage - SLAC wrist - SNAC wrist - Kienböck disease
 

  • References

  • 1 McAuliffe JA, Dell PC, Jaffe R. Complications of intercarpal arthrodesis. J Hand Surg Am 1993; 18 (6) 1121-1128
    CrossrefPubMedGoogle Scholar
  • 2 Siegel JM, Ruby LK. A critical look at intercarpal arthrodesis: review of the literature. J Hand Surg Am 1996; 21 (4) 717-723
    CrossrefPubMedGoogle Scholar
  • 3 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (5) 719-725
    CrossrefPubMedGoogle Scholar
  • 4 Galley I, Bain GI, McLean JM. Influence of lunate type on scaphoid kinematics. J Hand Surg Am 2007; 32 (6) 842-847
    CrossrefPubMedGoogle Scholar
  • 5 Fogg QA. Scaphoid variation and an anatomical basis for variable carpal mechanics [thesis]. Adelaide: University of Adelaide, Dept of Anatomical Sciences; 2004: 161-221
    Google Scholar
  • 6 Moritomo H, Viegas SF, Nakamura K, Da Silva MF, Patterson RM. The scaphotrapeziotrapezoidal joint. Part I: An anatomic and radiographic study. J Hand Surg Am 2000; 25 (5) 899-910
    CrossrefPubMedGoogle Scholar
  • 7 Haase SC, Berger RA, Shin AY. Association between lunate morphology and carpal collapse patterns in scaphoid nonunions. J Hand Surg Am 2007; 32 (7) 1009-1012
    CrossrefPubMedGoogle Scholar
  • 8 Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am 1990; 15 (4) 564-571
    CrossrefPubMedGoogle Scholar
  • 9 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (3) 358-365
    CrossrefPubMedGoogle Scholar
  • 10 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; 202 (202) 57-67
    PubMedGoogle Scholar
  • 11 Inoue G, Sakuma M. The natural history of scaphoid non-union. Radiographical and clinical analysis in 102 cases. Arch Orthop Trauma Surg 1996; 115 (1) 1-4
    CrossrefPubMedGoogle Scholar
  • 12 Peterson B, Szabo RM. Carpal osteoarthrosis. Hand Clin 2006; 22 (4) 517-528 , abstract vii
    CrossrefPubMedGoogle Scholar
  • 13 Armstrong AL, Hunter JB, Davis TRC. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (3) 340-341
    CrossrefPubMedGoogle Scholar
  • 14 McLean JM, Turner PC, Bain GI, Rezaian N, Field J, Fogg Q. An association between lunate morphology and scaphoid-trapezium-trapezoid arthritis. J Hand Surg Eur Vol 2009; 34 (6) 778-782
    CrossrefPubMedGoogle Scholar
  • 15 van Riet RP, Bain GI. Three-corner wrist fusion using memory staples. Tech Hand Up Extrem Surg 2006; 10 (4) 259-264
    PubMedGoogle Scholar
  • 16 Burgess RC. Anatomic variations of the midcarpal joint. J Hand Surg Am 1990; 15 (1) 129-131
    CrossrefPubMedGoogle Scholar
  • 17 Bain GI, Begg M. Arthroscopic assessment and classification of Kienböck's disease. Tech Hand Up Extrem Surg 2006; 10 (1) 8-13
    CrossrefPubMedGoogle Scholar
  • 18 Johnson RP. The acutely injured wrist and its residuals. Clin Orthop Relat Res 1980; 149 (149) 33-44
    PubMedGoogle Scholar
  • 19 Mayfield JK. Patterns of injury to carpal ligaments. A spectrum. Clin Orthop Relat Res 1984; 187 (187) 36-42
    PubMedGoogle Scholar
  • 20 Bain GI, McLean JM, Turner PC, Sood A, Pourgiezis N. Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept. J Hand Surg Am 2008; 33 (10) 1770-1776
    CrossrefPubMedGoogle Scholar
  • 21 Bain GI, Durrant A. An articular-based approach to Kienböck avascular necrosis of the lunate. Tech Hand Up Extrem Surg 2011; 15 (1) 41-47
    CrossrefPubMedGoogle Scholar
  • 22 Verhellen R, Bain GI. Arthroscopic capsular release for contracture of the wrist: a new technique. Arthroscopy 2000; 16 (1) 106-110
    PubMedGoogle Scholar
  • 23 Luchetti R, Atzei A, Fairplay T. Arthroscopic wrist arthrolysis after wrist fracture. Arthroscopy 2007; 23 (3) 255-260
    PubMedGoogle Scholar
  • 24 Chen F, Osterman AL, Mahony K. Smoking and bony union after ulna-shortening osteotomy. Am J Orthop 2001; 30 (6) 486-489
    PubMedGoogle Scholar
  • 25 Wollstein R, Watson HK. Scaphotrapeziotrapezoid arthrodesis for arthritis. Hand Clin 2005; 21 (4) 539-543 , vi
    CrossrefPubMedGoogle Scholar
  • 26 Vanhove W, De Vil J, Van Seymortier P, Boone B, Verdonk R. Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist. J Hand Surg Eur Vol 2008; 33 (2) 118-125
    PubMedGoogle Scholar
  • 27 Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNACwrist) and scapholunate advanced collapse (SLACwrist) in stage II. J Plast Reconstr Aesthet Surg 2008; 61: 1210-1218
    CrossrefPubMedGoogle Scholar
  • 28 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34: 256-263
    CrossrefPubMedGoogle Scholar
  • 29 Bain GI, Sood A, Ashwood A, Turner PC, Fogg G. Effect of scaphoid and triquetrum excision after limited stabilisation on cadaver wrist movement a laboratory study. J Hand Surg Eur Vol 2009; 34: 614-617
    PubMedGoogle Scholar
  • 30 Dutly-Guinand M, von Schroeder HP. Three-corner midcarpal arthrodesis and scaphoidectomy: a simplified volar approach. Tech Hand Up Extrem Surg 2009; 13 (1) 54-58
    CrossrefPubMedGoogle Scholar
  • 31 Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienböck's disease: the state of the art and a look at the future. J Hand Surg Eur Vol 2010; 35 (7) 549-554
    CrossrefPubMedGoogle Scholar
  • 32 Murray PM. Radioscapholunate arthrodesis. Hand Clin 2005; 21 (4) 561-566
    CrossrefPubMedGoogle Scholar
  • 33 Nagy L, Büchler U. Long-term results of radioscapholunate fusion following fractures of the distal radius. J Hand Surg [Br] 1997; 22 (6) 705-710
    PubMedGoogle Scholar
  • 34 Bain GI, Ondimu P, Hallam P, Ashwood N. Radioscapholunate arthrodesis—a prospective study. Hand Surg 2009; 14 (2-3) 73-82
    CrossrefPubMedGoogle Scholar
  • 35 Watson HK, Wollstein R, Joseph E, Manzo R, Weinzweig J, Ashmead IV D. Scaphotrapeziotrapezoid arthrodesis: a follow-up study. J Hand Surg Am 2003; 28 (3) 397-404
    CrossrefPubMedGoogle Scholar
  • 36 Kleinman WB, Carroll CT. Scaphotrapeziotrapezoid arthrodesis for treatment of chronic static and dynamic scapholunate. J Hand Surg Am 1990; 15 (3) 408-414
    CrossrefPubMedGoogle Scholar
  • 37 Ishida O, Tsai TM. Complications and results of scapho-trapezio-trapezoid arthrodesis. Clin Orthop Relat Res 1993; 287 (287) 125-130
    PubMedGoogle Scholar
  • 38 Weiss KE, Rodner CM. Osteoarthritis of the wrist. J Hand Surg Am 2007; 32 (5) 725-746
    CrossrefPubMedGoogle Scholar
  • 39 Delétang F, Segret J, Dap F, Dautel G. Chronic scapholunate instability treated by scaphocapitate fusion: A midterm outcome perspective. Orthop Traumatol Surg Res 2011;
    PubMedGoogle Scholar
  • 40 Vandesande W, De Smet L, Van Ransbeeck H. Lunotriquetral arthrodesis, a procedure with a high failure rate. Acta Orthop Belg 2001; 67 (4) 361-367
    PubMedGoogle Scholar
  • 41 Shin AY, Battaglia MJ, Bishop AT. Lunotriquetral instability: diagnosis and treatment. J Am Acad Orthop Surg 2000; 8 (3) 170-179
    CrossrefPubMedGoogle Scholar
  • 42 Kirschenbaum D, Coyle MP, Leddy JP. Chronic lunotriquetral instability: diagnosis and treatment. J Hand Surg Am 1993; 18 (6) 1107-1112
    CrossrefPubMedGoogle Scholar
  • 43 De Smet L, Janssens I, van de Sande W. Chronic lunotriquetral ligament injuries: arthrodesis or capsulodesis. Acta Chir Belg 2005; 105 (1) 79-81
    PubMedGoogle Scholar
  • 44 Carragee EJ, Hurwitz EL, Weiner BK. A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J 2011; 11 (6) 471-491
    CrossrefPubMedGoogle Scholar
  • 45 Bialocerkowski AE. Activity limitations and compensatory mechanism use following limited wrist fusion. Arthritis Rheum 2008; 59 (10) 1504-1511
    CrossrefPubMedGoogle Scholar