Radiocarpal Fusion: Indications, Technique, and Modifications

      Degenerative disorders of the wrist may affect isolated joints and inhibit normal functions of the wrist secondary to pain and stiffness. These processes that affect only the radiocarpal joint may be secondary to posttraumatic osteoarthritis, primary osteoarthritis, or rheumatoid arthritis. Radiocarpal wrist arthrodesis may help preserve some of the native wrist kinematics while alleviating pain and improving the range of motion. However, the surgeon must ensure that the patient’s pathologic process primarily affects the radiocarpal articulations while relatively sparing the midcarpal articulations. Depending on the location of the pathology, isolated radiolunate or radioscapholunate arthrodesis have been described to preserve some motion in the midcarpal joint. To maximize motion in the midcarpal joint after radiocarpal arthrodesis, techniques for distal scaphoid and triquetrum excision have been described. We report patient outcomes for various techniques and describe our preferred technique for radioscapholunate arthrodesis using distal scaphoid excision.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sandow M.J.
        • Fisher T.J.
        • Howard C.Q.
        • Papas S.
        Unifying model of carpal mechanics based on computationally derived isometric constraints and rules-based motion–the stable central column theory.
        J Hand Surg Eur Vol. 2014; 39: 353-363
        • Rainbow M.J.
        • Wolff A.L.
        • Crisco J.J.
        • Wolfe S.W.
        Functional kinematics of the wrist.
        J Hand Surg Eur Vol. 2016; 41: 7-21
        • Bain G.I.
        • McGuire D.T.
        Decision making for partial carpal fusions.
        J Wrist Surg. 2012; 1: 103-114
        • Kane P.M.
        • Vopat B.G.
        • Mansuripur P.K.
        • et al.
        Relative contributions of the midcarpal and radiocarpal joints to dart-thrower’s motion at the wrist.
        J Hand Surg Am. 2018; 43: 234-240
        • Bain G.I.
        • Sood A.
        • Ashwood N.
        • Turner P.C.
        • Fogg Q.A.
        Effect of scaphoid and triquetrum excision after limited stabilisation on cadaver wrist movement.
        J Hand Surg Eur Vol. 2009; 34: 614-617
        • Berkhout M.J.
        • Shaw M.N.
        • Berglund L.J.
        • An K.N.
        • Berger R.A.
        • Ritt M.J.
        The effect of radioscapholunate fusion on wrist movement and the subsequent effects of distal scaphoidectomy and triquetrectomy.
        J Hand Surg Eur Vol. 2010; 35: 740-745
        • Biswas D.
        • Wysocki R.W.
        • Cohen M.S.
        • Fernandez J.J.
        Radioscapholunate arthrodesis with compression screws and local autograft.
        J Hand Surg Am. 2013; 38: 788-794
        • Chamay A.
        • Vilaseca A.
        Radiolunate arthrodesis. Factor of stability for the rheumatoid wrist.
        Ann Chir Main. 1983; 2: 5-17
        • Garcia-Elias M.
        • Lluch A.
        • Ferreres A.
        • Papini-Zorli I.
        • Rahimtoola Z.O.
        Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy.
        J Hand Surg Am. 2005; 30: 8-15
        • Linscheid R.L.
        • Dobyns J.H.
        Radiolunate arthrodesis.
        J Hand Surg Am. 1985; 10: 821-829
        • McGuire D.T.
        • Bain G.I.
        Radioscapholunate fusions.
        J Wrist Surg. 2012; 1: 135-140
        • Motomiya M.
        • Iwasaki N.
        • Minami A.
        • Matsui Y.
        • Urita A.
        • Funakoshi T.
        Clinical and radiological results of radiolunate arthrodesis for rheumatoid arthritis: 22 wrists followed for an average of 7 years.
        J Hand Surg Am. 2013; 38: 1484-1491
        • Nagy L.
        • Büchler U.
        Long-term results of radioscapholunate fusion following fractures of the distal radius.
        J Hand Surg Br. 1997; 22: 705-710
        • McCombe D.
        • Ireland D.C.
        • McNab I.
        Distal scaphoid excision after radioscaphoid arthrodesis.
        J Hand Surg Am. 2001; 26: 877-882
        • Lameijer C.M.
        • Ten Duis H.J.
        • Dusseldorp I.V.
        • Dijkstra P.U.
        • van der Sluis C.K.
        Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review.
        Arch Orthop Trauma Surg. 2017; 137: 1499-1513
        • Argintar E.
        • Edwards S.
        Volar radioscapholunate arthrodesis for malunited distal radius fracture with unsalvageable wrist articular degeneration: case report.
        J Hand Surg Am. 2010; 35: 1089-1092
        • Shin E.K.
        • Jupiter J.B.
        Radioscapholunate arthrodesis for advanced degenerative radiocarpal osteoarthritis.
        Tech Hand Up Extrem Surg. 2007; 11: 180-183
        • Quinn M.
        • Kozin S.H.
        Radiolunate and radioscapholunate fusion for rheumatoid arthritis of the wrist.
        Atlas Hand Clin. 2005; 10: 281-288
        • Aletaha D.
        • Strand V.
        • Smolen J.S.
        • Ward M.M.
        Treatment-related improvement in physical function varies with duration of rheumatoid arthritis: a pooled analysis of clinical trial results.
        Ann Rheum Dis. 2008; 67: 238-243
        • Honkanen P.B.
        • Mäkelä S.
        • Konttinen Y.T.
        • Lehto M.U.
        Radiocarpal arthrodesis in the treatment of the rheumatoid wrist. A prospective midterm follow-up.
        J Hand Surg Eur. 2007; 32: 368-376
        • Ishikawa H.
        • Murasawa A.
        • Nakazono K.
        Long-term follow-up study of radiocarpal arthrodesis for the rheumatoid wrist.
        J Hand Surg Am. 2005; 30: 658-666
        • Esenwein S.A.
        • Fritz J.
        • Klinger H.M.
        • Gaissmaier C.
        • Martini F.
        • Sell S.
        Radio-ulnar and radio-scaphoid-lunate arthrodesis in chronic polyarthritis. Clinical and radiologic follow-up of 32 cases.
        Chirurg. 2004; 75: 176-184
        • Jüsten H.P.
        • Wessinghage D.
        Radiolunate arthrodesis in rheumatoid wrist--the modified Chamay technique with broadening of indications.
        Z Orthop Ihre Grenzgeb. 2003; 141: 316-321
        • Borisch N.
        • Haussmann P.
        Radiolunate arthrodesis in the rheumatoid wrist: a retrospective clinical and radiological longterm follow-up.
        J Hand Surg Br. 2002; 27: 61-72
        • Raven E.E.
        • Ottink K.D.
        • Doets K.C.
        Radiolunate and radioscapholunate arthrodeses as treatments for rheumatoid and psoriatic arthritis: long-term follow-up.
        J Hand Surg Am. 2012; 37: 55-62
        • Hindley C.J.
        • Stanley J.K.
        The rheumatoid wrist: patterns of disease progression. A review of 50 wrists.
        J Hand Surg Br. 1991; 16: 275-279
        • Bach A.W.
        • Almquist E.E.
        • Newman D.M.
        Proximal row fusion as a solution for radiocarpal arthritis.
        J Hand Surg Am. 1991; 16: 424-431
        • Montoya-Faivre D.
        • Pomares G.
        • Calafat V.
        • Dap F.
        • Dautel G.
        Clinical and radiological outcomes following radioscapholunate fusion.
        Orthop Traumatol Surg Res. 2017; 103: 1093-1098
        • Holleran A.M.
        • Quigley R.J.
        • Rafijah G.H.
        • Lee T.Q.
        Radioscapholunate arthrodesis with excision of the distal scaphoid: comparison of contact characteristics to the intact wrist.
        J Hand Surg Am. 2013; 38: 706-711
        • Pervaiz K.
        • Bowers W.H.
        • Isaacs J.E.
        • Owen J.R.
        • Wayne J.S.
        Range of motion effects of distal pole scaphoid excision and triquetral excision after radioscapholunate fusion: a cadaver study.
        J Hand Surg Am. 2009; 34: 832-837
        • Mühldorfer-Fodor M.
        • Ha H.P.
        • Hohendorff B.
        • Löw S.
        • Prommersberger K.J.
        • van Schoonhoven J.
        Results after radioscapholunate arthrodesis with or without resection of the distal scaphoid pole.
        J Hand Surg Am. 2012; 37: 2233-2239
        • Quadlbauer S.
        • Leixnering M.
        • Jurkowitsch J.
        • Hausner T.
        • Pezzei C.
        Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures.
        J Hand Surg Am. 2017; 42: 754.e1-754.e8
        • Ha N.B.
        • Phadnis J.
        • MacLean S.B.
        • Bain G.I.
        Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up.
        J Hand Surg Eur Vol. 2018; 43: 168-173
        • Bain G.I.
        • Ondimu P.
        • Hallam P.
        • Ashwood N.
        Radioscapholunate arthrodesis—a prospective study.
        Hand Surg. 2009; 14: 73-82
        • Rodgers J.A.
        • Holt G.
        • Finnerty E.P.
        • Miller B.
        Scaphoid excision and limited wrist fusion: a comparison of K-wire and circular plate fixation.
        Hand (N Y). 2008; 3: 276-281
        • Chung K.C.
        • Watt A.J.
        • Kotsis S.V.
        A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity.
        Plast Reconstr Surg. 2006; 118: 433-442
        • Vance M.C.
        • Hernandez J.D.
        • DiDonna M.L.
        • Stern P.J.
        Complications and outcome of four-corner arthrodesis: circular plate fixation versus traditional techniques.
        J Hand Surg Am. 2005; 30: 1122-1127
        • Kendall C.B.
        • Brown T.R.
        • Millon S.J.
        • Rudisill L.E.
        • Sanders J.L.
        • Tanner S.L.
        Results of four-corner arthrodesis using dorsal circular plate fixation.
        J Hand Surg Am. 2005; 30: 903-907
        • Mavrogenis A.F.
        • Flevas D.A.
        • Raptis K.
        • et al.
        Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients.
        Eur J Orthop Surg Traumatol. 2016; 26: 859-866
        • Stanley J.K.
        • Boot D.A.
        Radio-lunate arthrodesis.
        J Hand Surg Br. 1989; 14: 283-287

      Linked Article