Article

We studied a technical modification of Mannerfelt's total wrist fusion technique
in a series of 19 wrists. A fully intramedullary technique without dorsal carpal
fixation was used to protect the extensor tendons. Two intramedullary Rush pins
without dorsal staples were used during the arthrodesis procedure. Nineteen
rheumatoid arthritis wrists (2 bilateral cases) were reviewed with a mean
follow-up of 4.9 years (range 2-10 years). Clinical outcomes were assessed using
the VAS pain scale, DASH-score and wrist strength measurements. Wrist fusion was
assessed on AP and lateral X-rays of the wrist. The position of the carpal Rush
pin entry points and distal hook orientation were also assessed. Pain was 8.9
preoperatively and 1.1 at the last follow-up with 95% patients satisfied. Mean
DASH-score was 46.9 points. The pinch strength was 79% and the grip strength was
68% of the contralateral wrist. Carpal height, carpal anterior subluxation and
ulnar deviation were stable at the last follow-up. All of the wrists were in
straight position and no extensor tendon ruptures were noted. Fusion was complete
in all cases within 6 to 12 weeks, except in one case. The technical modification
proposed in the current study -intraosseous fixation only- appears to be a good
alternative to Mannerfelt's original technique. Every case treated with this
modified technique had good functional results and none required pin removal.
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Langue : FRANCAIS