Rev. bras. ortop. vol.50 número5

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w w w . r b o . o r g . b r

Original

Article

Is

arthrodesis

still

a

good

indication

for

non-inflammatory

arthrosis

of

the

wrist?

夽

Bruno

de

Araujo

Silva

a,∗

,

Marcos

Vinícius

Marciano

Campos

de

Souza

a

,

Felipe

Moura

Carrasco

a

_,

_Gustavo

_Adolfo

_Costa

_Melo

a

_,

_Luiz

_Eduardo

_Luz

_Barreiros

a

_,

Pedro

José

Labronici

b

a_Hospital_Estadual_de_{Traumatologia}_e_Ortopedia_Dona_Lindu,_Paraíba_do_Sul,_RJ,_Brazil

b_Faculdade_de_Medicina_de_Petrópolis_(FMP),_Petrópolis,_RJ,_Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received30July2014

Accepted18September2014

Availableonline9September2015

Keywords: Arthrosis Wrist

Arthrodesisofthewrist

a

b

s

t

r

a

c

t

Objective:Theaimofthisstudywastoobjectivelyandsubjectivelyevaluatewristfunction

aftertotalarthrodesis,amongpatientswithsequelaeofnon-inflammatoryarthritiswho

weretreatedwithrigidinternalfixationusingaDCPplate.

Methods:Thirty-two patients with sequelaeof non-inflammatory degenerativearthritis

weretreatedusingtotalarthrodesisofthewrist.Ofthese,twopatientsweretreatedwith

Kirschnerwiresandfourdiscontinuedthetreatment,thusleaving26patients.The

indi-cationforarthrodesisofthewristwasthepresenceofintracarpalpathologicalconditions:

eightwristspresentedsequelaefromfracturesofthedistalradius;13hadsequelaefrom

fracturesofthescaphoid;andfivehadsequelaefromKienbock’sdisease.Thecaseswere

evaluatedusingthevisualanaloguescale(VAS),themusclestrengthtest,theJebsen–Taylor

functionaltestandtheBuck-Gramckotest.

Results:Itwasobservedthattherewerenosignificantdifferencesatthelevelof5%,inthe

variablesofgripstrength,VAS,Jebsen–TaylorfunctionaltestorBuck-Gramcko/Lohmann

test,betweenthepathologicalconditions.

Conclusion:Totalarthrodesisofthewristusingaplateinthedorsalregionwasshowntobe

asafeandefficienttechniqueforpatientswithdifferenttypesofpathologicalarthrosisof

thewrist,sinceitdidnotcauseanyimportantfunctionalincapacityandbroughtgreatpain

relief.

Ltda.Allrightsreserved.

夽

WorkperformedintheHospitalEstadualdeTraumatologiaeOrtopediaDonaLindu,ParaíbadoSul,RJ,Brazil.

∗ _{Corresponding}_author_.

E-mail:[email protected](B.deAraujoSilva).

http://dx.doi.org/10.1016/j.rboe.2015.08.017

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Artrodese

ainda

é

uma

boa

indicac¸ão

na

artrose

não

inflamatória

do

punho?

Palavras-chave: Artrose Punho

Artrodesedopunho

r

e

s

u

m

o

Objetivo: Avaliarobjetivaesubjetivamenteafunc¸ãodopunho,apósartrodesetotal,em

pacientescomsequelasdeartritenãoinflamatóriatratadoscomfixac¸ãointernarígidacom

placatipoDCP.

Métodos:Foramtratados32pacientescomsequelasdeartritedegenerativanãoinflamatória

comartrodesetotaldopunho.Desses,doisforamtratadoscomfiosdeKirschnere

qua-trodescontinuaramotratamento.Restaram26.Asindicac¸õesparaaartrodesedopunho

forampacientescompatologiasintracarpais.Oitopunhosapresentavamsequeladefratura

radiodistal,13sequelasdefraturadoescafoideecincosequelasdedoenc¸adeKienbock.

Foramusadosparaaavaliac¸ãoaescalavisualanalógica(EVA),otestedeforc¸amuscular,o

testefuncionaldeJebsen-TayloreotestedeBuck-Gramcko.

Resultados: Observou-senãoexistirentreaspatologiasdiferenc¸asignificativa,nonívelde

5%,nasvariáveisdaforc¸adepreensão,EVA,testefuncionaldeJebsen-Taylorede

Buck-Gramcko/Lohmann.

Conclusão: Aartrodesetotaldepunho,complacanaregiãodorsal,demonstrouseruma

técnicaeficienteeseguraparaospacientescomdiferentestiposdepatologiasdeartrosede

punho,pornãocausarincapacidadefuncionalimportanteetrazerumgrandealíviodador.

EditoraLtda.Todososdireitosreservados.

Introduction

Total arthrodesisofthe wrist has becomea standard

pro-cedurefordegenerativewristarthritis.1,2_{Traditionally,}_wrist

arthrodesisisthetreatmentforwristarthritisthatdoesnot

respondtoanti-inflammatorymedications,immobilizersand

corticosteroidinjections,eventhoughitsubstantially

dimin-ishesthefunctioningofthisjoint.3

Arthritis in this joint has several causes, including the

following:sequelaeofintra-articularfractures,skewed

con-solidation subsequent to distal fracturing of the radius,

tearing of the interosseous ligaments, avascular necrosis,

inflammatorydiseasesandcongenitaldiseases.2_In_cases_of

non-inflammatorydiseases,wristarthrodesisprovidespain

reliefandincreasesthegripstrengthofthehand.

Many techniques have been used to perform wrist

arthrodesis, such as use of crossed Kirschner wires,

intramedullary pins, and plates and screws with or

with-out associateduse of bonegrafts.4,5 _Rigid_internal_fixation

withdifferenttypesofplatesnotonlyreducesthepainand

enablesthe returnto work,but alsomakesosteosynthesis

easyandsafe.Throughusingdorsalplates,consolidationrates

ofbetween93and100%havebeenachieved,withlow

compli-cationrates.1,2,6–9

Theaimofthepresentstudywastoevaluatelimb

func-tionaftertotalwristarthrodesisinpatientswithsequelaeof

non-inflammatoryarthritisthatwastreatedbymeansofrigid

internalfixationwithaDCPplateinthedorsalregionofthe

wrist.

Material

and

methods

BetweenOctober21,2010,andJanuary2014,32patientswith

sequelae of non-inflammatory degenerative arthritis were

treatedbymeansoftotalwristarthrodesis.Theprocedurewas

firstlyapprovedbythe hospital’sethicscommittee.Among

these, twoweretreated withKirschnerwiresandfour

dis-continued the treatment. Thus, 26 patients remained.The

inclusion factorswerethat thepatientswould have

seque-lae of intra-articular wrist fractures, skewed consolidation

subsequenttodistalfracturingoftheradiusandrestrictive

carpal pathologicalconditions(such asKienbock’sdisease).

The exclusion factors were the presence of inflammatory

degenerativediseasesandextracarpalpathologicalconditions

(suchasneuromusculardiseases,lesionsofperiarticularsoft

tissues,tumorresectionsandsequelaeofnerveinjuries).All

thepatientsweretreatedbymeansofrigidinternalfixation

withaDCPplateinthedorsalregionofthewrist.Sex,age,side

anddominancearepresentedinTable1.

Theindicationsforwristarthrodesiswerecasesofpatients

with intracarpal pathological condition. Eight wrists

pre-sented sequelaeofradiodistalfractures,13 hadsequelaeof

fracturesofthescaphoidandfivehadsequelaeofKienbock’s

disease.

Table1–Generaldescriptionofthesample.

Characteristic Description Quantity Percentage

Sex Male 20 77%

Female 6 23%

Side Right 17 65%

Left 9 35%

Dominance Yes 17 65%

No 9 35%

Source:Filesofthehospitalservice.

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Surgicaltechnique

Allthepatientswereoperatedundergeneralanesthesia,

com-plementedwithblockingofthebrachialplexusandpneumatic

ischemiaofthelimbaffected.Thelongitudinaldorsalaccess

routewasopened abovethethirdmetacarpal.The

retinac-ulum ofthe extensors was opened betweenthe third and

fourthtunnels.Thetendonofthelongextensorofthethumb

wasmovedawayradially,andtheextensoroftheindex

fin-ger and the common extensor ofthe fingers were moved

towardtheulna.Neurectomyoftheendbranchofthe

pos-teriorinterosseousnervewasperformedinaroutinemanner.

ThejointcapsulewasopenedastwoU-shapedflapswiththeir

basesattheradiusandulna.Thecartilageoftheradiocarpal

andintercarpaljointswasremovedasfarasthesubchondral

bone,andatLister’stubercle.Wed chosetoperform

curet-tageofthedorsalfaceofthecapitateandthedistalborderof

theradius.Weappliedtemporarydressingsandreleasedthe

pneumatictourniquet.Arectangularbonegraftwasremoved

fromtheipsilateralregion,alongwithspongybone.Weagain

appliedpneumaticischemiatothelimbandremovedthe

tem-porary dressing. Thespongy bonegraft was placedin the

radiocarpal and intercarpaljoints.TheDCP plate forsmall

fragmentswasmodeledwithameanangleof10◦_in_extension

andosteosynthesiswasperformedusingtheprinciplesofthe

AOtechnique,withsixcorticalgraftsinthethirdmetacarpal

andbetweensixandeightinthe radius,underradioscopic

control.Inthespacebetweenthecapitateandtheplate,we

placedaboneblockfromtheiliaccrest,underpressure.Thus,

nofixationscrewswereusedinthecarpus.Thejointcapsule

wasclosedwhenpossible.Inallthecases,weclosedthe

reti-naculumoftheextensorsandsuturedtheskinusingsimple

stitches.Wedidnotuseanydrainsoranyimmobilizationwith

splints,and onlyusedcompressivedressings.Thepatients

wereinstructedtoactivelymobilizetheirfingersduringthe

immediatepostoperativeperiod.Theywereassessedinthe

first,thirdandsixthweeksandthereaftereverytwomonths

untilthesixthpostoperativemonth.

Subjectiveevaluation

Thepatientswereaskedtomakeasubjectiveevaluationof

theirpostoperativepainusingavisualanaloguescale(VAS).10

TheVASisanefficientinstrumentformeasuringtheintensity

ofthepainandithasbeenusedinresearchandclinicaltrials.

Itconsistsofahorizontallinemeasuring10cm.Oneendis

labeled“nopain” andthe other,“worstpainpossible”. The

patientisaskedtomarkonthislinethepointcorrespondingto

thepainintensitylevelthatheisexperiencingatthatmoment.

Objectiveevaluation

Radiographsinanteroposteriorandlateral viewson allthe

patientswereanalyzedinordertodeterminethewrist

fix-ation position and the time taken for consolidation to be

achieved.

Thefunctionalevaluationincludedamusclestrengthtest

inwhichadynamometerwasusedtomeasurehandgrip;and

thefunctional testofJebsenet al.,11 _which_is_composed_of

manipulativetaskssimilartothoseperformedinday-to-day

Table2–Buck-Gramcko/Lohmannscores.

Criteria Score

Rangeofmotionofthefingersandforearm

Extensionofthemetacarpophalangealnormal orwithslightdeficit

3

Deficitofextensionofthe metacarpophalangeal

−1

Deficitoffingerflexion −1 Deficitofpronosupination −1

Useofhand

Complete 2

Limitedinrelationtospecialuse 1 Limitedinrelationtoactivitiesofdailyliving 0

Pain

Nopain 2

Painduringheavywork 1 Painduringallactivities 0

Grip

75–100%ofthenormalside 2

50–75% 1

<50% 0

Subjectiveevaluation

Improved 1

Worsened −2

Excellent,9–10;Good,7–8;Satisfactory,5–6;Poor,<5.

activities andisdivided into sevensubtests: (1)writing;(2) simulationofthetaskofturningcardsover;(3)liftingupsmall objects;(4)simulationofusingaspoonforeating;(5)pilingup blocks(i.e.usingpiecesfromthegameofdraughts/checkers); (6)liftinguplargelightobjects;and(7)liftinguplargeheavy objects.Thepercentagescoreisobtainedfrom case-control standardizedvaluesproducedbythisauthor.Inaddition,the Buck-Gramckotest,12 _which_is_specific _for_arthrodesis,_was

usedasanobjectiveassessmentforarthrodesis,asshownin

Table2.

Statisticalmethodology

Thedescriptiveanalysispresentedtheobserveddatainthe

formoftables.Thedatawereexpressedasmeans,standard

deviations,medians,minimumsandmaximumsfor

numer-ical data and as frequencies (n) and percentages (%) for

categoricaldata(qualitative).

The comparative analysis on the variables of grip

strength, VAS, Jebsen–Taylor functional test and

Buck-Gramcko/Lohmann test between the three pathological

conditions (sequelae of scaphoid fractures, sequelae of

radiodistal fractures and Kienbock’s disease) was defined

usingtheKruskal–WallisANOVAtest(fornumericalvariables)

andFisher’sexacttest(forcategoricalvariables).

Non-parametrictestswereusedbecausethevariablesdid

not present normal (Gaussian) distribution, giventhat the

hypothesisofnormalityaccordingtotheShapiro–Wilkstest

was rejected. The criterion used to determinesignificance

was thelevel of5%.Thestatistical analysiswasprocessed

using the SAS 6.11 software (SAS Institute, Inc., Cary, NC,

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Table3–Descriptionofthevariablesinthewholesample.

Variable n Mean SD Median Minimum Maximum

Gripstrength–wristwitharthrodesis(kg) 26 17.6 11.2 14.7 1.7 42.8 Gripstrength–wristwithoutarthrodesis(kg) 26 31.3 10.0 32.8 10.2 46.9 Deltaforgripstrength(kg) 26 −13.7 12.5 −13.8 −39.8 7.4 Relativedeltaforgripstrength(%) 26 −41.7 36.8 −47.7 −90.7 32.7

VAS–before(points) 26 8.9 1.4 10 4 10

VAS–after(points) 26 3.2 2.9 3 0 10

DeltaforVAS(points) 26 −5.7 3.0 −5.5 −10.0 1.0 RelativedeltaforVAS(%) 26 −64.2 31.3 −63.3 −100.0 11.1 Totaltime–wristwitharthrodesis(s) 26 115.0 76.8 86.9 56.6 351.4 Totaltime–wristwithoutarthrodesis(s) 26 90.6 23.1 89.3 48.5 139.8 Deltafortotaltime(s) 26 24.4 67.5 3.4 −27.2 247.7 Relativedeltafortotaltime(%) 26 24.3 63.0 4.2 −25.4 238.8

Buck-Gramcko/Lohmann(points) 26 5.3 3.2 5.5 0 10

Source:Filesofthehospitalservice. SD,standarddeviation.

Results

Themeantimetakeforconsolidationtobeachievedforthe entiresamplewas10.8 weeks.Forthe casesofsequelaeof scaphoid fractures,the mean time was 10.4 weeks(range: 6–20).Forthecasesofsequelaeofradiodistalfractures,the meantimewas9.4weeks(range:5–24).Forthecasesof seque-lae of Kienbock’s disease, the mean time was 11.6 weeks (range:8–18).Itisimportanttoemphasizethatnocasesof pseudarthrosisoccurred.Thetotallengthoffollow-upforthe samplewas18.5months.

Characterizationofthestudysample

Thisstudyhadtheaimofoutliningtheprofileof26patients subsequenttowristarthrodesis.

The absolute delta is the difference in measurements between the wrist with arthrodesisand the wrist without arthrodesis. In this study, a negative delta expresses the number of kg/point/second less than in the wrist without arthrodesis.

The relative delta is the percentage difference between the two wrists in relation to the wrist without arthrode-sis. In this study, a negative relative delta expresses the percentage kg/point/second less than in the wrist without arthrodesis.

Tables 3–6 present the mean, standard deviation (SD),

median, minimum and maximum of the variables in the

whole sampleand inthedifferent pathological conditions:

sequelaeofscaphoidfractures,sequelaeofradiodistal

frac-turesandKienbock’sdisease,respectively.

Table7presentsthefrequencies(n)and percentages(%)

ofthecategoricalvariables inthewholesampleandinthe

differentpathologicalconditions.

The next objective was to ascertain whether there was

anysignificantdifferenceinthevariables(gripstrength,VAS

score,Jebsen–TaylorfunctionaltestandBuck-Gramckotest),

betweenthepathologicalconditions.

Table 8 presents the mean, standard deviation (SD)

and median of the variables of grip strength, VAS score,

Jebsen–TaylorfunctionaltestandBuck-Gramckotest,

accord-ing to the pathological condition (sequelae of scaphoid

fractures, sequelae of radiodistal fractures and Kienbock’s

Table4–Descriptionofthevariablesforthecasesofsequelaeofscaphoidfractures.

DeltaforVAS(points) 13 −5.5 2.5 −5.0 −10.0 −3.0 RelativedeltaforVAS(%) 13 −67.2 28.5 −70.0 −100.0 −30.0 Totaltime–wristwitharthrodesis(s) 13 106.3 79.2 71.9 56.6 351.4 Totaltime–wristwithoutarthrodesis(s) 13 84.6 22.2 82.4 48.5 111.3 Deltafortotaltime(s) 13 21.7 70.2 2.1 −25.9 247.7 Relativedeltafortotaltime(%) 13 21.8 68.1 2.0 −25.4 238.8

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Table5–Descriptionofthevariablesforthecasesofsequelaeofradiodistalfractures.

DeltaforVAS(points) 8 −6.0 3.0 −5.0 −10.0 −2.0 RelativedeltaforVAS(%) 8 −64.6 27.3 −58.6 −100.0 −20.0 Totaltime–wristwitharthrodesis(s) 8 102.5 30.0 97.9 61.0 147.0 Totaltime–wristwithoutarthrodesis(s) 8 93.6 15.6 95.4 72.3 118.7

Deltafortotaltime(s) 8 8.9 31.8 0.7 −17.6 74.7

Relativedeltafortotaltime(%) 8 12.0 41.0 0.9 −18.3 103.2

Table6–DescriptionofthevariablesforthecasesofsequelaeofKienbock’sdisease.

DeltaforVAS(points) 5 −5.6 4.7 −6.0 −10.0 1.0

RelativedeltaforVAS(%) 5 −55.8 47.6 −60.0 −100.0 11.1 Totaltime–wristwitharthrodesis(s) 5 157.7 116.8 112.5 65.8 350.7 Totaltime–wristwithoutarthrodesis(s) 5 101.5 33.6 81.8 73.9 139.8 Deltafortotaltime(s) 5 56.3 100.9 4.7 −27.2 214.1 Relativedeltafortotaltime(%) 5 50.5 82.4 6.3 −19.5 156.8

disease)andthecorrespondingdescriptivelevel(pvalue)from theKruskal–WallisANOVAtest(nonparametric).

It was observed that there were no significant differ-ences betweenthe pathological conditionsatthe 5%level,

with regard to the variables of grip strength, VAS score, Jebsen–TaylorfunctionaltestandBuck-Gramckotest.

Table9presentsthe frequencies(n)and percentages(%)

relating to the side with arthrodesis, dominant side and

Table7–Descriptionofthevariablesinthewholesampleandinthedifferentpathologicalconditions.

Variable Total(n=26) Scaphoid(n=13) Radiodistal(n=8) Kienbock(n=5)

n % n % n % n %

Sidewitharthrodesis

Right 17 65.4 9 69.2 6 75 2 40

Left 9 34.6 4 30.8 2 25 3 60

Dominantside

Right 17 65.4 9 69.2 6 75 2 40

Left 9 34.6 4 30.8 2 25 3 60

Result

Excellent 5 19.2 2 15.4 2 25 1 20

Good 4 15.4 2 15.4 1 12.5 1 20

Satisfactory 5 19.2 4 30.8 1 12.5 0 0

Poor 12 46.2 5 38.5 4 50 3 60

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T able 8 – Compar a ti v e anal ysis betw een the differ ent pa thological conditions. V aria b le Sequelae of scaphoid fr actur es Sequelae radiodistal fr actur es Kienboc k’ s disease p v alue a Mean ± SD Med Mean ± SD Med Mean ± SD Med Grip str ength – wrist with arthr odesis (kg) 20.2 ± 12.2 14.0 15.2 ± 10.2 15.7 14.7 ± 10.3 11.8 0.49 Grip str ength – wrist without arthr odesis (kg) 35.5 ± 6.8 35.8 30.8 ± 9.9 27.3 21.3 ± 11.6 21.6 0.060 Delta for grip str ength (kg) − 15.2 ± 12.9 − 17.7 − 15.7 ± 14.2 − 15.7 − 6.6 ± 7.0 − 10.1 0.28 Relati v e delta for grip str ength (%) − 41.8 ± 37.4 − 57.5 − 47.3 ± 38.8 − 53.8 − 32.5 ± 38.1 − 32.1 0.71 VA S – befor e (points) 8.5 ± 1.7 9 9.1 ± 1.2 10 9.8 ± 0.4 10 0.14 VA S – after (points) 2.9 ± 2.6 3 3.1 ± 2.6 4 4.2 ± 4.4 4 0.88 Delta for VA S (points) − 5.5 ± 2.5 − 5.0 − 6.0 ± 3.0 − 5.0 − 5.6 ± 4.7 − 6.0 0.91 Relati v e delta for VA S (%) − 67.2 ± 28.5 − 70.0 − 64.6 ± 27.3 − 58.6 − 55.8 ± 47.6 − 60.0 0.91 T otal time – wrist with arthr odesis (s) 106.3 ± 79.2 71.9 102.5 ± 30.0 97.9 157.7 ± 116.8 112.5 0.40 T otal time – wrist without arthr odesis (s) 84.6 ± 22.2 82.4 93.6 ± 15.6 95.4 101.5 ± 33.6 81.8 0.59 Delta for total time (s) 21.7 ± 70.2 2.1 8.9 ± 31.8 0.66 56.3 ± 100.9 4.7 0.91 Relati v e delta for total time (%) 21.8 ± 68.1 2.0 12.0 ± 41.0 0.9 50.5 ± 82.4 6.3 0.85 Buc k-Gr amc ko/Lohmann (points) 5.6 ± 2.6 6 5.4 ± 3.7 5 4.6 ± 4.2 3 0.79 Sour ce : F iles of the hospital service . SD , standar d de viation. a Kruskal–W allis ANO V A.

Buck-Gramckoclassification,accordingtothedifferent

patho-logicalconditions(sequelaeofscaphoidfractures,sequelaeof

radiodistalfracturesand Kienbock’sdisease)and the

corre-spondingdescriptivelevel(pvalue)fromFisher’sexacttest.

Itwasobservedthattherewerenosignificantdifferences

between the pathological conditions at the 5% level, with

regardtothesidewitharthrodesis,dominantsideand

Buck-Gramckoclassification.

Discussion

When orthopedic surgeons are faced with patients

pre-sentingnon-inflammatorywristarthritiswhoarecandidates

for surgery, wrist arthrodesis should be avoided

when-everpossible.Nevertheless,thisreconstructionprocedureis

well establishedand has been proven tohave great value

for many pathological conditions. Historically, it has

pre-sentedsatisfactorypostoperativeresults,sincetheincapacity

thatarthrodesisproducescanbecompensatedfor,provided

that the patient’s shoulder, elbow, forearm and hand are

normal.13–15 _Although _several_techniques _for_treating _wrist

arthrosis exist, the introduction of dynamic compression

platesbytheAOgroup,16_used_in_association_with_bone_grafts,

hasledtohighratesofgoodresultsfromarthrodesis,which

hasmadeitthemostpopularmethod.16,17

According tothe literature,the consolidation rates

sub-sequent to the procedure have been 98–100%, with good

resultsregardingpainreliefandimprovementgripstrength,

andsatisfactionratesofbetween80and100%.Thepatients

report that they would like to haveundergone this

proce-dure before other techniques. Arthrodesis has little or no

repercussion in relation to loss ofmobility and long-term

complications.1,18,19

In the present study, in comparing the sides with and

withoutarthrodesis,thegripstrengthofthehandwaslower

on the side with arthrodesis in all the groups evaluated:

57.5% in the cases of sequelae from scaphoid fractures;

53.8% in the cases of sequelae from radiodistal fractures;

and 32.1% inthe casesofKienbock’s disease,without

pre-senting any significant difference. This demonstrated that

diminutionofmusclestrengthoccurredbothinpathological

conditionsofsequelaeofintra-articularfracturesofthewrist

and insituations ofskewedconsolidation afterdistal

frac-turingoftheradiusandunderrestrictivecarpalpathological

conditions.

Inanalyzing thestateofpain usingthe VAS,thewrists

withandwithoutarthrodesiswerecompared.Completepain

reliefafterwristarthrodesisshouldbeexpectedinthe

major-ityofpatients.20_In_the_present_study,_the_patients_reported

improvementsinpainlevelsinallthegroupsevaluated:70%

improvementoradecreaseoffivepointsontheVASscalein

thecasesofsequelaefromscaphoidfractures;58.6%orfive

pointsinthecasesofsequelaefromradiodistalfractures;and

60%orsixpointsinthecasesofKienbock’sdisease,without

presentinganysignificantdifference.Itwasobservedthatover

thesepatients’follow-upperiod,mostofthemdidnotreport

anypainorneedanyregularanalgesia.

TheJebsen–Taylorfunctionaltest, whichiscomposedof

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Table9–Comparativeanalysisbetweenthepathologicalconditions.

Variable Scaphoid(n=13) Radiodistal(n=8) Kienbock(n=5) pvalue

n % n % n %

Sidewitharthrodesis

Right 9 69.2 6 75 2 40 0.48

Left 4 30.8 2 25 3 60

Dominantside

Right 9 69.2 6 75 2 40 0.48

Left 4 30.8 2 25 3 60

Result

Excellent/Good 4 30.8 3 37.5 2 40 0.77

Satisfactory 4 30.8 1 12.5 0 0

Poor 5 38.4 4 50 3 60

Source:Filesofthehospitalservice.

not demonstrate any significant incapacity from arthrode-sis,in comparingthe wrists withand without arthrodesis. In observing the results, the taskswere carried out more slowly on the sidewith arthrodesis,by differences of2.1s amongthe patientswithsequelaefrom scaphoidfractures, 0.9s amongthose withsequelae from radiodistalfractures and6.3samongthosewithKienbock’sdisease,incomparison withthesidewithoutarthrodesis.Theseresultsmaysuggest thatpatientswithsequelaefromKienbock’sdiseasepresenta greatertendencytowardfunctionalincapacity.However,our limitednumberofcasesdoesnotallowustoreachthis con-clusion.

In this study, the Buck-Gramcko test, which is specific forarthrodesis and consistsof anobjective assessment of arthrodesis,demonstratedthatthepatientspresentedresults rangingfromgoodtosatisfactory.Themeanscoresweresix pointsforsequelaeofscaphoidfractures,fiveforsequelaeof radiodistalfracturesandthreeforKienbock’sdisease.

Thestrong pointofthis study was that it analyzedthe resultsfromthreedifferentpathologicalconditionsofwrist arthrosisafterthearthrodesisprocedure.Throughthis,the indications for using this type of procedure can be con-sidered. Theweakpointwas the unsatisfactorynumber of patients,giventhatwristarthrodesisisanuncommon pro-cedure,which prevented usfrom reaching aconclusion of greaterprecision.Anotherpointwasthelackofcomparison ofpainamongthepatientsbeforeandaftertheprocedure.

Themostfrequentcomplications were tendinitisofthe extensors,ineightpatients,andtheneedtoremovetheplate insix.Othercomplicationsincludedonecaseofcontracture oftheextensors, onecaseofsuperficialinfection thatwas resolvedthroughantibiotictherapyandonecaseofloosening ofthesynthesismaterial.

Conclusion

Totalarthrodesisofthewristusingaplateinthedorsalregion wasshowntobeasafeandefficienttechniqueforpatients withdifferentpathologicalconditionsofwristarthrosis,since itdidnotcauseanysignificantfunctionalincapacityandgave risetogreatpainrelief.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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