Wrist Arthrodesis: Clinical and Ultrasonographic Trial

Oliveira, JP; Serra, S; Néri, A

http://hdl.handle.net/10400.4/1437

Use this identifier to reference this record.

Name:	Description:	Size:	Format:
Wrist Arthrodesis.pdf		2.84 MB	Adobe PDF	Download

Send Feedback

Authors

Oliveira, JP

Serra, S

Néri, A

Abstract(s)

INTRODUCTION: The wrist arthrodesis has become a well-established procedure on the treatment of various diseases that affect the radiocarpal joint with the objective of pain relief and restoration of joint stability, allowing a recovery of gripping function and lifestyle. OBJECTIVES: Evaluate the functional outcomes of wrist arthrodesis in patients with advanced symptomatic inflammatory or degenerative arthritis and evaluate the residual synovitis by ultrasonography. METHODS: Review the patients who underwent a total wrist arthrodesis in our Hospital between 1999 and 2009, by a comparative and functional study. The study population was divided into two groups: Inflammatory Rheumatic Disease (IRD group) and another that included the remaining cases (RC group). For functional evaluation we used the Buck-Gramcko&Lohman (BGL) Evaluation for Total Wrist Function and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. Pain levels were measured pre- and postoperatively according to the Visual Analogue Scale (VAS). A General Electric P5 Power Doppler Ultrasound with a high-resolution linear 7-12 MHz array was used to identify local synovitis. Mann-Whitney, Wilcoxon and Chi-Square tests were applied for statistical evaluation. p <0.05 was considered statistically significant. RESULTS: According to the study criteria we selected 38 patients. From these, 7 were treated bilaterally, with a total of 45 total wrist arthrodesis evaluated (IRD group n=25 vs RC group n=20). The predominant gender was the female (78.4%), the average age at the time of surgery was 50.0 ±14.2 years and the mean postoperative follow-up was 4.8 ± 2.6 years. Regarding to the most common surgical indication, on the RC group we had 40% of post-traumatic arthritis and on the IRD group, 96% had rheumatoid arthritis.The most frequent surgical technique used on the IRD group was Mannerfelt (52%) vs AO/ASIF plate osteosynthesis (95%) on the RC group, Darrach procedure was associated in 37.8% of all cases. IRD group presented a greater time for bone union (3.6 vs 2.9, p=0.228), fewer postoperative complications (12.0% vs 35.0%, p=0.069) and fewer cases of material extraction (20.0% vs 25.0%, p = 0.481).There was a lower deficit of pronosupination on the RC group (76% vs 60%, p=0.204), and this group also presented a better assessment on the DASH score (13.0 vs. 22.4, p=0.153). 75.0% of the RC group had a BGL score with excellent to good results vs 32.0% on the IRD group, p = 0.005.All patients improved their VAS between pre-and postoperatively (8.0 vs 2.0 on the IRD group and 6.5 vs 1.5 on the RC group, p = 0.000). After surgery, most patients maintained the previous profession (90% on the RC vs 56% on the IRD group, p = 0.013).The ultrasonographic wrist evaluation of the IRD group revealed local synovitis in 2 cases as also as extensor tenosynovitis of the fingers in other 2 cases. All of these 4 cases were of low intensity and without inflammatory activity identified by power-Doppler signal. CONCLUSION: Although being a retrospective study it allows us to evaluate the effectiveness of wrist arthrodesis, on its various indications, with encouraging functional outcomes and pain relief levels on patients with and without inflammatory rheumatic disease.