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Comparison of Surgical Outcomes in Partial versus Total Wrist Denervation
Josha Woodward, MD, MCR1; Tuan Nguyen, MD, DSS, FACS2; Jenny Lee Nguyen, MD3; Michael Wheatly, MD2; Mary Russell, NP2; Stephen Peterson, MD2
1Rush University, Chicago, IL; 2Portland VA Medical Center, Portland, OR; 3Michigan State University, Lansing, MI

Introduction: Partial wrist denervation (PWD) and total wrist denervation (TWD) are minimally invasive options to treat chronic pain related to articular degeneration or chronic instability. Herein, we report a comparative study of the efficacy and outcomes between these procedures.

Methods: The medical records of all patients who underwent PWD or TWD at the Portland VA Medical Center from 1999 through 2015 were reviewed. Patients who underwent a concomitant wrist procedure at the time of denervation were excluded. Patients that required further wrist surgery for pain were classified as treatment failures. Patients who died or were lost to follow-up were considered successes if they had not undergone salvage surgery. For the remaining patients, mini-DASH scores were calculated at the most recent follow-up.

Results: Ninety-six patients (93 males and 3 females) met inclusion criteria. The predominant diagnoses were: carpal arthritis, scaphoid nonunion, SLAC, Keinbock, STT arthritis, and sequelae of prior distal radius fracture. Twenty-nine patients underwent PWD between 1999 to mid-2008 and 67 underwent TWD between late-2008 to 2015. Four PWD (12.9%) and 16 TWD (23.9 %) went on to require additional surgery. A trend towards failure was observed in younger patients and the diagnosis of SLAC wrist; these results were not statistically significant (P>0.05). The average time to failure was 9.2 years (95%ĘCI 7.3-11.1 years) for PWD and 3.9 years (95% CI 3.4-4.5 years) for TWD (P <0.0001). Mini-DASH scores were obtained for 60 patients, 19 had PWD at an average follow-up of 11.9 years (range 7.8-17.0 years) and 41 had TWD at an average follow-up of 5 years (range 0.1-11.9 years). The average mini-DASH score for PWD was 30.7 and 30.5 for TWD; this difference was not statistically significant (P=0.76).

Conclusion: Wrist denervation is an efficacious treatment for chronic wrist pain with a 79% overall rate of success in preventing or delaying progression to salvage surgery.1,2 In our study, neither treatment was statistically superior. However, better pain relief and an increased time to treatment failure was observed in those undergoing partial wrist denervation. The overall failure rate for PWD was 12.9% (mean time to failure 9.2 years) and was 23.9% (mean time to failure 3.9 years) for TWD. Patients greater than 50 years-old and those who suffered from arthritis demonstrated reduced rates of failure and salvage surgery regardless of denervation method. Even for patients who may ultimately fail, denervation may provide durable and meaningful pain reduction.

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