Madelung Deformity: Radioscapholunate Arthrodesis With a Neo-DRUJ

Background Madelung deformity is a rare wrist anomaly that causes considerable pain while restricting function. In this study, we describe a radioscapholunate (RSL) arthrodesis with a neo-distal radioulnar joint (DRUJ) in Madelung deformity patients with an abnormal sigmoid notch and compare results to patients after a reverse wedge osteotomy. Methods Six wrists underwent RSL arthrodesis with a neo-DRUJ in a two-phase approach: (1) modified RSL arthrodesis with triquetrectomy; and (2) distal scaphoidectomy. Seven wrists underwent a reverse wedge osteotomy procedure. Results There were no differences found in postoperative pain, grip strength, or range of motion (ROM), apart from extension, which was decreased after RSL arthrodesis with a neo-DRUJ. Quality of life and Michigan Hand Outcomes Questionnaire scores were similar. Conclusions Although clinical outcome parameters are not different among the two groups, the RSL arthrodesis with construction of a neo-DRUJ could prove a valid treatment option for a subset of patients with a severely affected sigmoid notch.

Reconstruction of Radioscaphocapitate Ligament in Treatment of Ulnar Translation

Background This article measures the life quality, clinical, and functional outcomes of a patient who had undergone reconstruction of the radioscaphocapitate ligament (RSL), using brachioradialis tendon in the treatment of ulnar translation of the carpus. Case Description We present a 36-year-old man with ulnar translation in his left, nondominant wrist, after fall accident. Reconstruction of the RSL was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 85 degrees and supination was 90 degrees and digit motion was full. Disabilities of the Arm, Shoulder and Hand score of 5, Visual Analog Scale of 0, and grip strength of 82% were obtained compared with the unaffected side. Wrist radiographic aspects showed radiocarpal joint congruency. The period of fixator treatment was 8 weeks. Good stability and joint congruency of the radiocarpal joint were obtained. Good radiographic, clinical, and functional results were obtained improving the quality of life of the patient. Literature Review The treatment of ulnar translation is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the type of intervention have been a matter of controversy in the literature. Would radiocarpal joint be stable when reconstruction of the RSL using brachioradialis tendon was obtained? Is it possible to reduce an ulnar translation with this technique? Clinical Relevance We would like to suggest that the radiocarpal ligament reconstruction will improve the outcome. We believe that this technique will make the wrist more stable and functional. We agree that the best time to perform the corrections is early. The authors prefer to first reconstruct the RSL and then the radiocarpal ligament suture or radioscapholunate arthrodesis.

A blinded, randomized trial comparing bicolumnar arthrodesis to radioscapholunate arthrodesis in scapholunate advanced collapse II arthritis: a pilot study

The purpose of this study was to compare the outcome of scaphoid excision with capitolunate and triquetrohamate arthrodesis (bicolumnar arthrodesis) to radioscapholunate arthrodesis in patients with scapholunate advanced collapse (SLAC) II wrist arthritis. Twelve patients with symptomatic SLAC II arthritis were recruited and randomized to receive either bicolumnar arthrodesis or radioscapholunate arthrodesis. The primary outcome was wrist function as assessed by the patient rated wrist evaluation. Secondary outcomes included range of motion, grip strength and the Mayo wrist score. A linear mixed-effects model was used to evaluate the effects of bicolumnar arthrodesis and radioscapholunate arthrodesis in treating SLAC II arthritis. Patients receiving bicolumnar arthrodesis had more improvement in their wrist function compared with patients receiving radioscapholunate arthrodesis. A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis. In SLAC II arthritis, the expected benefit of preserving the midcarpal joint was not observed. Scapholunate ligament disruption makes radioscapholunate arthrodesis a technically challenging operation. Level of evidence: I