Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?

Rev Bras Ortop. 2015 Sep 9;50(5):578-85. doi: 10.1016/j.rboe.2015.08.017. eCollection 2015 Sep-Oct.

Abstract

Objective: The aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non-inflammatory arthritis who were treated with rigid internal fixation using a DCP plate.

Methods: Thirty-two patients with sequelae of non-inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen-Taylor functional test and the Buck-Gramcko test.

Results: It was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen-Taylor functional test or Buck-Gramcko/Lohmann test, between the pathological conditions.

Conclusion: Total arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief.

Objetivo: Avaliar objetiva e subjetivamente a função do punho, após artrodese total, em pacientes com sequelas de artrite não inflamatória tratados com fixação interna rígida com placa tipo DCP.

Métodos: Foram tratados 32 pacientes com sequelas de artrite degenerativa não inflamatória com artrodese total do punho. Desses, dois foram tratados com fios de Kirschner e quatro descontinuaram o tratamento. Restaram 26. As indicações para a artrodese do punho foram pacientes com patologias intracarpais. Oito punhos apresentavam sequela de fratura radiodistal, 13 sequelas de fratura do escafoide e cinco sequelas de doença de Kienbock. Foram usados para a avaliação a escala visual analógica (EVA), o teste de força muscular, o teste funcional de Jebsen-Taylor e o teste de Buck-Gramcko.

Resultados: Observou-se não existir entre as patologias diferença significativa, no nível de 5%, nas variáveis da força de preensão, EVA, teste funcional de Jebsen-Taylor e de Buck-Gramcko/Lohmann.

Conclusão: A artrodese total de punho, com placa na região dorsal, demonstrou ser uma técnica eficiente e segura para os pacientes com diferentes tipos de patologias de artrose de punho, por não causar incapacidade funcional importante e trazer um grande alívio da dor.

Keywords: Arthrodesis of the wrist; Arthrosis; Wrist.