Session X - Upper Extremity

*Health Status after Wrist Arthrodesis for Posttraumatic Arthritis

Lauren P. Adey, MD; David C. Ring, MD; Jesse B. Jupiter, MD; Massachusetts General Hospital, Boston, Massachusetts, USA (a-AO Foundation)

Background: Total wrist arthrodesis is regarded as the most predictable way to relieve the pain of posttraumatic wrist arthritis. Wrist arthrodesis is also believed to be compatible with a high level of upper extremity functioning. The upper-extremity-specific and general health status of patients with total wrist arthrodesis after trauma have not been evaluated.

Methods: With use of an IRB-approved protocol, 22 patients were evaluated an average of 6 years after total wrist arthrodesis for posttraumatic arthritis. Upper-extremity-specific and general health status were measured by using the DASH and SF-36 instruments, respectively. Patient satisfaction and their interest in pursuing a wrist mobilizing procedure, should one become available, were also assessed. Objective assessment included grip strength, digit range of motion, and radiographic fusion.

Results: The average DASH score was 25 (range, 4 to 57). The average physical component score of the SF-36 was 39 (range, 15 to 60), and the average mental component score was 52 (range, 44 to 64). Nineteen patients reported wrist pain, including severe pain in 5 patients. Two of the patients had ulnar nerve damage at the time of their original injury and continued to have nerve-related pain. Fifteen patients were satisfied or very satisfied with the result of the fusion, 5 patients were neutral, and 2 patients were mildly dissatisfied. Twenty patients would elect to have a motion-restoring procedure, should one become available. One patient required a second operation to obtain successful fusion. Subsequent procedures included neuroma excision in one patient, and hardware removal from six. Grip strength averaged 79% of that of the uninvolved wrist, and five of the patients had stiff digits.

Conclusion: Substantial dysfunction was noted on both upper-extremity-specific and general health status measures after total wrist arthrodesis for posttraumatic conditions. Pain was improved but not eliminated. Although some of the pain and dysfunction were related to associated problems, the interest in motion-restoring procedures expressed by out patients reflects the residual pain and functional limitations associated with a wrist that has undergone arthrodesis.