Arthroscopic Radiocarpal Fusion for Post-Traumatic Radiocarpal Arthrosis

Abstract

Post-traumatic arthrosis of the radiocarpal joint is not uncommon following distal radius fracture. Intra-articular fracture and poorly reduced extra-articular fracture are at risk. Radiocarpal fusion helps to abolish pain by removing the source of pain, stabilize the wrist segments to halt progressive arthritis and preserve useful wrist motion and function. It is indicated whenever there is irreversible damage to the radiocarpal joint articulation while the mid-carpal joint is relatively preserved. The wide intra-articular exposure of the wrist joint under arthroscopic view provides an excellent ground for arthroscopic intervention. Combining with percutaneous fixation technique, arthroscopic radiocarpal fusion potentially can generate the best possible functional outcome by minimizing trauma to soft tissue and hence favour motion preservation. From Mar 2005 to Aug 2008, the author had performed four cases of arthroscopic radioscapholunate fusion and two cases of radiolunate fusion. Through the radiocarpal portals, the corresponding articular surfaces were denuded of cartilage using arthroscopic burr. Bone substitutes were inserted and impacted to the fusion site through cannula under direct arthroscopic view. Final fixation could be accomplished by multiple K wires or cannulated screw system. Early mobilization was encouraged. Surgical complications were minor, including pin tract infection and delayed union in one case. Uneventful radiological union was obtained in five cases. Non-union was encountered in one case requiring revision open fusion. Average follow-up was 28.7 months. Symptom was resolved and functional motion gained in all cases. The average arc of motion was 64° flexion/extension and 42° radio-ulnar deviation. All surgical scars were almost invisible, and aesthetic outcome was excellent.