Article

Radioscapholunate (RSL) fusion is typically performed following
wrist trauma. It addresses the pain caused by radiocarpal osteoarthritis but
reduces the wrist's mobility.
The objective of this study was to determine the
long-term clinical and radiological outcomes of this procedure.
METHODS: This was a retrospective study of all wrists operated for RSL fusion in
our surgery unit over a 12-year period. The clinical analysis consisted of joint
amplitudes, grip strength, pain (VAS) and functional scores (PRWE, QuickDash,
Mayo Wrist Score). The radiological analysis focused on bone fusion and the
presence of midcarpal osteoarthritis. RESULTS: This surgery procedure was
performed on 48 wrists. Of these, 34 patients were available for review,
including 6 who had subsequently undergone total wrist fusion after the RSL
procedure. The average follow-up was 53 months. Flexion/extension and radioulnar
deviation were 56 degrees and 30 degrees , respectively. Grip strength in the
operated wrist was 71% of the contralateral wrist. The mean pain level was 3 out
of 10. The PRWE, QuickDash and Mayo Wrist Score were 35.7, 44.5 and 57.2,
respectively. Seventy-nine percent of patients were satisfied with the outcome.
The fusion rate was 71%, the midcarpal osteoarthritis rate was 64% and the STT
osteoarthritis rate was 46%. DISCUSSION: Reduced wrist range of motion in
patients who have undergone RSL fusion helps to preserve satisfactory function in
the majority of patients; however, the functional outcome scores point to some
hindrance in day-to-day activities. Nonunion occurred in nearly one-quarter of
patients and appears to be preventable by excision of the distal pole of the
scaphoid (DPS). Midcarpal osteoarthritis develops in most wrists over the
long-term and appears to be inevitable. CONCLUSION:
RSL fusion is a palliative
procedure that preserves some of the wrist's mobility. However, it is a difficult
procedure that has a significant nonunion rate. Excision of the DPS may
contribute to lowering the nonunion rate.
CI - Copyright (c) 2017. Published by Elsevier Masson SAS.

Langue : FRANCAIS