Wrist Fusion and Back to Work

Transcription

1 Wrist Fusion and Back to Work Marc J. Richard, M.D. Associate Professor Department of Orthopaedic Surgery Durham, North Carolina

2 42 yo Ironworker, Failed Scope Debridement

3 FUSION ARTHROPLASTY

4 FUSION ARTHROPLASTY

5 FUSION ARTHROPLASTY

6 FUSION ARTHROPLASTY

7 FUSION ARTHROPLASTY

8 FUSION ARTHROPLASTY

9 FUSION ARTHROPLASTY

10 FUSION ARTHROPLASTY

11 42 yo Ironworker, Failed Scope Debridement

12 JHS, Retrospective review of 7 TWA, 15 Arthrodesis - Mean Age 65 yo - Mean f/u 5 years TWA may offer increased functional outcomes

13 JHS, 2013

14 JHS, 2005 JBJS, 1996 JHS, 1995 Overall satisfaction, good pain relief and good function

15 JHS, 2011 No prospective, randomized trials comparing TWA and Arthrodesis in Non-rheumatoid patients

16 JHS, 2011 No prospective, randomized trials comparing TWA and Arthrodesis in Non-rheumatoid patients

17 JBJS, 2011 Survival Rates 5 years 75% 7 years 60% 9 years 50% Complications Superficial infection, wound issues, instability, carpal component loosening

18 Total Wrist Arthrodesis Indications Post-traumatic OA of RC and mid-carpal joints Failed limited wrist arthrodesis Failed arthroplasty Paralysis of wrist/hand Rheumatoid arthritis

19 Total Wrist Arthrodesis Bone Graft ICBG Distal ulna Distal radius Proximal Row of Carpus Hardware Plates Steinmann Pins

20 Total Wrist Arthrodesis

21 Total Wrist Arthrodesis Bone Graft Historically, corticocancellous (ICBG) AO plates cancellous ICBG Distal radius, carpus Distal ulna RA typically does not require bone graft to achieve union

22 Total Wrist Arthrodesis Plates AO Plates Specialty Plates Nails Steinmann Pins RA

23 Total Wrist Arthrodesis Joints Always RS, RL, CL Position Unilateral Slight Extension, Slight Ulnar Deviation Bilateral One in Slight Extension One in Neutral to Slight Flexion

24 Total Wrist Arthrodesis Position Weiss et al, JHS pts s/p total wrist fusion Jebson hand function test, 64% tasks w/i 2 SD in fusion wrist (compared to 78% in norm) Perineal care most difficult Pryce, J Biomech 1980 Slight extension, ulnar deviation to max grip Weiss and Hastings, JHS extension Brumfield and Champoux, CORR extension

25 Total Wrist Arthrodesis

26 Total Wrist Arthrodesis

27 Total Wrist Arthrodesis

28 Total Wrist Arthrodesis Union Rates AO Technique Field et al, JHS-Br pts, 100% union Weiss and Hastings, JHS pts, 100% union Larsson, CORR pts, 100% union

29 Total Wrist Arthrodesis Complications Hardware 19% 3.5mm plates, rare in fusion plates CTS 4% to 11% post-op; 2/3rds require release Evaluate for CTS pre-op DRUJ 0% to 3.5%, may resolve with steroid injection Grip Strength Expect 72% of normal, plateaus at 1 year

30 42 yo Ironworker, Failed Scope Debridement

31

32 Ironworker

33 Ironworker

34 Summary Arthrodesis is a consideration for painful, arthritic joints Excellent outcomes, predictable and durable for high-demand patients Arthroplasty is evolving but remains indicated for older, low demand patients High complication rate, low survival

35 Duke University Medical Center