Distal Radius Fractures and Wrist Prosthesis
Jean-Luc Roux, MD
Institut Montpellierain de la main, montpellier, France
Management of distal radius fractures (DRF) by wrist prosthesis is a solution proposed by some french surgeons in cases of comminuted intra-articular fractures in the elderly. This concept has long been used successfully in the hip, shoulder, elbow. We report our experience with a replacement and resurfacing prosthesis of the distal radius.
Materials - Methods
Since 2005, 29 prostheses were implanted on 29 patients (27 women and 2 men), the mean age was 77 years old, from 38 to 102. 27 cases concerned elderly and osteoporotic women : 22 times for complex intra-articular fractures and 5 times for malunions. In 2 cases the procedure concerned men : a middle-age with low functional demand and complex intra-articular fracture, a young man with a pathologic fracture (geant cell tumor).
25 patients were reviewed with one year follow-up. A 90 years old woman died 4 months after surgery, she retained a good result at the wrist. 3 patients have less than 1 year of follow-up. 20 patients were satisfied or very satisfied, 4 patients were moderatly satisfied, 1 patient was disatisfied. 16 patients had no pain (VAS=0), 8 patients complained of pain during strength activities or barometric pain, 1 patient was painfull with a CRPS. DASH score was 26. Mean mobilities were : extension 62°, flexion 37°, ulnar deviation 26°, radial deviation 21°, pronation 72°, supination 68°. Mean strength was 79 % of the controlateral strength. The implants were perfectly stable on the x-rays, in 16 cases we found peri-prosthetic ossifications. At the longer follow-up, none of the prosthesis needs a revision. A Darrach procedure was performed for a painful DRUJ, after 3 years of follow-up on a patient with rheumatoid arthritis.
The optimal treatment of complex DRF in elderly is controversial. Wrist hemi-arthroplasty is a simple solution particulary indicated when metaphyseal instability and intra-articular comminution are associated. The clinical results are obtained more quickly and with fewer complications than with ORIF. Other French surgeons have designed prostheses for DRF. These prostheses replace only the distal carpal facet and not the sigmoid notch, so a distal ulna resection must frequently be associated.
Management of DRF by a prosthesis is a solution we can now propose in elderly, particularly in cases of intra-articular comminution and metaphyseal instability. Our choice prosthesis is an hemi-arthroplasty resurfacing not only the carpal facet but also the sigmoid notch.
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