Arthroscopic Partial Wrist Fusion

Abstract

Partial wrist fusion is a widely accepted concept and technique in salvaging a failing wrist with preservation of motion and function, with adequate pain control. Conventionally the open surgical approach may induce excessive stiffness, infringe vascularity, impair bony union, and prolong rehabilitation. Arthroscopic approach provides unimpeded articular view of the wrist and hence offers excellent ground for various forms of partial wrist fusion. Combining with strong percutaneous fixation technique, arthroscopic partial wrist fusion can potentially generate a better functional outcome by preserving the maximal motion pertained with each type of partial wrist fusion.

From Nov 1997 to Oct 2011, arthroscopic partial wrist fusion was performed in 23 patients of an average age of 42 years old (range 18–68 years old). These include STT fusion in three, scaphoidectomy plus four corners fusion in five, scaphoidectomy plus capitolunate fusion in four, lunatectomy plus scaphocapitate fusion in three, radioscapholunate fusion in four, radiolunate fusion in two, and luno-triquetral fusion in two. Through the radiocarpal or midcarpal joint, the corresponding articular surfaces were denuded of cartilage using arthroscopic burr and curette. Carpal bones involved in the fusion process were then transfixed with K wires percutaneously after the alignment being corrected under fluoroscopic control. Autogenous cancellous bone graft or bone substitute could be inserted and impacted to the fusion site through a cannula under the direct arthroscopic view. The final fixation was achieved with multiple K wires or cannulated screws. Early mobilization was encouraged.

Surgical complications were few and minor, including pin tract infection, skin burn, and delay union. Radiological union of the fusion site was obtained in 19 cases, stable asymptomatic fibrous union in three cases, and definite nonunion requiring revision in one case. At an average follow-up of 59.9 months (range 11–112 months), the symptom was resolved or improved and the functional motion was obtained in all cases. The surgical scars were almost invisible and the aesthetic outcome was excellent.

In conclusion, arthroscopic partial wrist fusion is a viable option for patients suffering from posttraumatic or nonprogressive wrist arthritis who would like to preserve useful wrist motion with good aesthetic outcome. Union rate is high and complication uncommon.