Nelson D L, Manske P R, Pruitt D L, Gilula L A, Martin R A
Department of Orthopaedics, University of California, San Francisco 94143-0728.
J Hand Surg Am. 1993 Nov;18(6):1113-20. doi: 10.1016/0363-5023(93)90412-V.
Lunotriquetral arthrodesis has been recommended for the treatment of disabling pain at the lunotriquetral joint after more conservative measures have failed. We retrospectively analyzed a series of 22 patients treated with a lunotriquetral arthrodesis for presence of fusion, method of fixation, duration of immobilization, carpal alignment, pain relief, and ability to return to work. Fixation with a Herbert screw supplemented with a Kirschner wire (K-wire) was superior to fixation with K-wires alone. Immobilization longer than 6 weeks was superior to immobilization less than 6 weeks. Combined use of a Herbert screw supplemented with a K-wire and immobilization longer than 6 weeks resulted in union in all patients, even when performed for nonunion after a prior attempted arthrodesis. Pain was improved in all patients; all patients who previously were working returned to work. Routine posteroanterior and lateral x-ray films often failed to adequately profile the arthrodesis site. We recommend using a Herbert screw supplemented with a K-wire for lunotriquetral arthrodesis and keeping the patient in a cast until fusion is documented, usually at least 8 weeks. Fluoroscopic spot views or tomograms are recommended to demonstrate bone fusion.
