Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion,Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature



Ingo Schmidt1, *
1 Medical Centre Wutha-Farnroda (Department of Orthopaedics, Hospital Bad Salzungen GmbH, Germany, Teaching Hospital of the Friedrich-Schiller-University Jena, Germany), Ringstr. 20, 99848 Wutha-Farnroda, Germany

Abstract

Background:

Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.

Methods:

The aim of this articleis to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.

Results:

In trend, proximal row carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-relatedpostoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total wrist arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total wrist fusion (TWF)is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair themovement of the wrist.

Conclusion:

Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.

Keywords: Osteoarthritis, Four-corner fusion, Proximal row carpectomy, Total wrist arthroplasty, Total wrist fusion, Denervation.


Abstract Information


Identifiers and Pagination:

Year: 2019
Volume: 13
Publisher Item Identifier: EA-TOORTHJ-2019-17

Article History:

Received Date: 10/03/2019
Revision Received Date: 24/06/2019
Acceptance Date: 25/06/2019
Electronic publication date: 23/08/2019
Collection year: 2019

© 2019 Ingo Schmidt.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Medical Centre Wutha-Farnroda (Department of Orthopaedics, Hospital Bad Salzungen GmbH, Germany, Teaching Hospital of the Friedrich-Schiller-University Jena, Germany), Ringstr. 20, 99848 Wutha-Farnroda, Germany; E-mail: schmidtingo62@googlemail.com