Bhat Anil K, Pai G Mithun, Acharya Ashwath M, Manohar Amruth
Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India.
Indian J Orthop. 2023 Apr 17;57(7):1092-1099. doi: 10.1007/s43465-023-00884-9. eCollection 2023 Jul.
Various intramedullary or dorsally based fusions have been utilised to perform wrist arthrodesis. Although the dorsal plate is rigid and well constructed, the standard of care was replenishing the arthrodesis site with an iliac crest bone graft. Due to the high morbidity of the donor site, alternatives such as distal radius bone grafts have gained popularity. In this study, wrist arthrodesis was performed with a locally accessible trapezoidal wedge graft from the distal radius and a low-profile reconstruction plate to evaluate the radiological and functional outcome.
We retrospectively reviewed 22 wrists, 14 brachial plexus injuries, 4 post-traumatic injuries, and 4 rheumatoid arthritis patients, with a mean follow-up of 31 months. Union was evaluated on radiography. The functional outcomes were evaluated using a visual analog scale incorporated into a questionnaire.
All 22 fusions united successfully, with a mean duration of 12 weeks and a wrist position of an average 17.5 degrees of extension and 6 degrees of ulnar deviation. The aesthetics of the wrist showed the most significant change, and overall satisfaction levels increased.
A locally accessible cortico-cancellous graft from the dorsum of the radius is a reliable alternative to an iliac crest or carpal bone graft with high potential for the union. It also serves as a stable strut in our construct, allowing us to use a low-profile reconstruction plate. The Reconstruction (3.5 System) plate can be used safely with excellent results and a low implant prominence or breakage risk.
已采用各种髓内或背侧融合术来进行腕关节融合。尽管背侧板坚固且结构良好，但标准治疗方法是用髂嵴骨移植来补充关节融合部位。由于供体部位的高发病率，诸如桡骨远端骨移植等替代方法已越来越受欢迎。在本研究中，使用来自桡骨远端的局部可获取的梯形楔形移植骨和低轮廓重建钢板进行腕关节融合，以评估影像学和功能结果。
我们回顾性分析了22例腕关节，其中14例为臂丛神经损伤，4例为创伤后损伤，4例为类风湿性关节炎患者，平均随访31个月。通过X线片评估融合情况。使用纳入问卷中的视觉模拟量表评估功能结果。
所有22例融合均成功，平均融合时间为12周，腕关节位置平均为背伸17.5度和尺偏6度。腕关节的美观度变化最为显著，总体满意度提高。
来自桡骨背侧的局部可获取的皮质松质骨移植是髂嵴或腕骨移植的可靠替代方法，融合潜力高。它在我们的结构中也起到稳定支柱的作用，使我们能够使用低轮廓重建钢板。重建（3.5系统）钢板可以安全使用，效果良好，植入物突出或断裂风险低。
