What are the medium-term results after a radioscapholunate fusion in the treatment of a post-traumatic osteoarthtritis of wrist?
Between 1/92 and 8/04 73 Patients with post-traumatic radiocarpal osteoarthritis (mostly following an intra-articular distal radius fracture) were treated by radioscapholunate (RSL) fusion. These patients were retrospectively evaluated with a minimum follow-up period of 18 months. In 16 of the 73 patients (22%) the RSL fusion was converted to a complete wrist arthrodesis at an average of 9 (3-69) months after the partial fusion. Of the remaining 57 patients 39 returned for a clinical and radiological examination at an average of 59 (19-140) months postoperatively. Pain, functional limitations, range of motion, grip strength, return to work, and patient satisfaction were evaluated. Non-union of the fusion and carpal osteoarthritis were assessed radiologically.
The DASH score averaged 39 points (3-80). 7 patients (18%) had no pain. 19 patients (49%) had pain only with activities. 13 patients (32%) complained of pain at rest, but 38 of 39 patients reported an improvement in comparison to the preoperative situation. 28 patients (72%) returned to work. 38 of 39 patients would have the operation done again (97%). Wrist extension averaged 31 degrees and flexion 29 degrees , ulnar deviation was 20 degrees and radial deviation 14 degrees on average, pronation averaged 81 degrees and supination 71 degrees . Grip strength was 32 kg on average (72% of the opposite side). The radiological assessment showed in 8 patients (21%) a radiocarpal non-union (7 RS, 1 RL). Arthritic changes of the adjacent carpal joints (STT, SC, LC or LT) were found in 20 patients (51 %) without a significant effect on the clinical outcome.
Radioscapholunate fusion is a treatment option for radiocarpal osteoarthritis to preserve a functional range of motion. Patient satisfaction is high although functional limitations and residual pain can exist. A progressive arthrosis of the adjacent carpal joints can frequently be observed, but mostly without affecting the clinical outcome. The non-union rate is high, but mostly well tolerated. If the procedure fails a conversion to a complete wrist fusion may be necessary. In most cases this occurs early following the partial wrist fusion.