Amundsen, Asgeir

Abstract Purpose To evaluate the functional outcome and complications following primary ulnar head or total distal radial ulnar joint (DRUJ) arthroplasty in patients who have a partial or total wrist fusion. Methods We conducted a retrospective review of 33 primary DRUJ implants in 31 patients who had a partial or total wrist fusion. Follow-up time averaged 67 months. There were 11 partial and 22 total wrist fusions with 22 ulnar head prosthesis and 11 total DRUJ implants. The mean age of the patients was 49 years. Eighty-one percent had previous surgeries with an average number of 4.6 previous wrist procedures. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion (ROM), and post-operative complications were noted. Results The pain scores improved in 67% of the patients. The Mayo Wrist Score improved significantly from a mean of 39 preoperatively to 51 postoperatively. The grip strength and pro-supination remained stable. The wrist ROM also remained stable in the patients with partial wrist fusions. During the follow-up period, 10 (30%) of the DRUJ implants were explanted, with a trend toward higher explantation rates in total wrist fusions with one in the partial fusion group and nine in the total wrist fusion group. Four of the explantations happened in the first postoperative year. Nineteen (61%) of the patients required a second surgery for a DRUJ implant-related complication; this rate was similar between the partial and total fusion groups. Conclusions DRUJ replacement resulted in improved pain scores and Mayo wrist scores in the majority of patients; however, the combination of primary DRUJ arthroplasty and total wrist fusion was associated with high complication rates. Surgeons should be aware of the high complication rate seen with DRUJ arthroplasty when combined with total wrist fusion.

Abstract Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.