Wrist & Hand

Wrist replacement in trauma?

A suggestion not often heard at trauma conferences for patients with fractures of the distal radius is that of wrist replacement for comminuted fractures of the distal radius. This concept is unlikely to ever gain real momentum due to the excellent results of both non-operative treatments and fixation combined with the relatively poor long-term outcomes of radio-carpal arthroplasty. Researchers in Limoges (France) did not, however, let this conventional wisdom put them off, and they present a retrospective study of eight patients with a mean age of 80 years. Amazingly, these patients were all treated for comminuted fractures of the distal radius with primary radiocarpal prosthesis. After 17 to 36 months (mean 25 months), all patients were followed up by an independent surgeon. Outcomes were assessed using wrist ROM and grip strength. Clinical outcome assessment included the Quick DASH (18.2;6.82 to 29.55) and pain VAS (2.33; 0 to 4). As would be expected with such a short follow-up period, radiographs did not reveal any implant loosening or ulnar translation of the carpus. The authors cite one of the advantages of their wrist resurfacing implant as a rapid recovery and return to independent living in this group of elderly dependent patients. The authors’ protocol required three weeks immobilisation in a cast followed by self-rehabilitation.¹⁰ This is, to our knowledge, the only description of this treatment modality for fractures of the distal radius in the elderly and does appear to show early reported good results. While the indications for radiocarpal arthroplasty in trauma of the elderly appear extremely limited, it may represent an attractive option for carefully selected active patients to keep in mind especially to those surgeons wishing to fly in the face of conventional wisdom.