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after revision of the distal component of a TWA for bone loosening.
A 54-year-old, right-handed man fell on the right wrist, causing forced hyperextension. He had undergone right TWA (Universal Total Wrist; KMI, San Diego, CA) 9 years previously for rheumatoid arthritis. Radiographs showed periprosthetic fracture at the tip of the radial component. Computed tomography showed no signs of subsidence or loosening of radial component (Fig. 1). Fracture reduction and internal fixation were achieved with the assistance of fluoroscopic guidance. A locking compression plate using 4 distal unicortical screws and 5 proximal bicortical screws secured fixation. The fracture site was grafted by autologous cancellous bone from the patient's olecranon. At the 12-month follow-up, the patient had recovered painless range of motion. X-rays showed bone healing and good alignment without signs of loosening.
Figure 1A Coronal and B sagittal computed tomography scan images of the wrist demonstrating a proximal fracture in the tip of the radial component. C Anteroposterior and D lateral radiographs of the wrist showing evidences of bone-healing fracture.
J de Vos M. High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years.
For treatment, we considered the fracture pattern, the computed tomography scan findings, and the implant's stability intraoperatively. In our case, open reduction and internal fixation of a radius periprosthetic fracture in TWA with a well-integrated implant was successful.
References
Cobb T.K.
Beckenbaugh R.D.
Biaxial long-stemmed multipronged distal components for revision/bone deficit total-wrist arthroplasty.
J de Vos M. High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years.
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