抄録
A stable and painless wrist joint is a prerequisite for the hand for it to function fully. We have occasionally seen cases in which spontaneous radio -lunate fusion occurred maintaining a stable and painless wrist. Based on observation of those cases, we have treared wrists which had ulnar shift and/or volar subluxation of the carpus by surgical fusion of the proximal carpal row to the radius, combined with Darrach's procedure.
Comparative clinical and radiological studies were made on radio-lunate (R-L) fusion done in 14 wrists of 13 cases and radio-scapho-lunate (R-S-L) fusion done in 6 wrists of 6 cases. The average follow-up period after surgery was 22.7 months in the former group, and 16.2 months in the latter. There was no significant difference between these two groups.
Clinical assessment revealed that both groups had obtained marked relief of pain and significant increase of gripping power. In the R-L fusion group, the postoperative range of dorsi and palmar flexion was limited to about two thirds of the preoperative one, while in the R-S-L fusion group, the postoperative range of dorsi and palmar flexion was limited to about one half of the preoperative one. But no cases complained of the limitation of ROM, because of the compensatory mobility in elbow and finger joints.
Radiological assessment revealed that the carpus had been reduced to its anatomical position and stabilized in most cases, with a union rate of about 65%. Midcarpal angulation and scapholunate dissociation, which are the indices of carpal instability, were also improved. No remarkable differences were found in the radiological findings of these two groups.
In conclusion, limited wrist fusion is a useful procedure to make the moderately destroyed rheumatoid wrist painless and stable if the midcarpal joint is preserved. Fusion between the lunate and radius is usually sufficient but radio-scapho-lunate fusion is occasionally needed for cases with severe destruction between the scaphoid and radius or ankylosis between the scaphoid and lunate.
