Abstract
The problem: A few operative procedures were used for radiolunate fusion for stabilization of the rheumatoid wrist. Because of minor stability of these fixations, cast immobilization of the wrist is necessary for several weeks, which may lead to a limited wrist motion through the scar of the joint capsule. Non-union and loosening of the osteosynthesis material were described for all of these procedures.
Method: a three dimensional bended mini-titanium-T-plate (produced by Martin/Germany) with an additional oblique screw withstands the forces acting on the fixed lunate, as there are palmar flexion, dorsal extension, radial and ulnar abduction, rotation along the longitudinal axis, palmar and ulnar shift. The high primary stability results from a three point fixation of the lunate an the form of the plate. Because of this very stable fixation, early exercise of the wrist is allowed from the third day after operation. After reduction of the soft tissue swelling the palmar cast is replaced by a ready-made wrist splint, which can be removed by the patient for exercise of the wrist three times a day.
Results: 20 radiolunate fusions have been performed by this new technique since the year 2000. Bone healing was achieved in all. Cast immobilization after surgery was reduced from a period of 3 to 8 weeks for the first 9 wrists to the period of soft tissue swelling (6 to 10 days) for the 11 wrists operated at least. Through early exercise of extension and flexion of the wrist, the average range of wrist extension and flexion rose from 60 degrees in the first group to 70 degrees in the latter.
Conclusion: The radiolunate fusion with a three dimensional bended minititanium-T-plate and an oblique screw neutralizes the forces on the lunate. Because of this, early exercise of the wrist is possible to minimize limitation of the wrist motion through the shrinking scar of the joint capsule. Furthermore the light wrist splint is very comfortable to the patient, because it gives low stress on the other joints and can be removed easily for exercise and skin care.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
