The role of VFG in wrist arthrodesis: Long term results in a series of 11 patients and literature review. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Innocenti, Marco; Calabrese, Sara; Menichini, Giulio; Delcroix, Luca; Innocenti, Alessandro
• Is Part Of: Injury. Volume 52:Issue 12(2021)
• Page Start: 3624
• Page End: 3634
• Publication Date: 2021-12
• Subjects: Total wrist fusion -- Vascularized fibula -- Distal radius reconstruction -- Giant cell tumor -- Wrist joint -- Vascularized bone graft -- Radius -- Bone transplantation -- Arthrodesis; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.11.004
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Wrist fusion is the standard of care in case of severe traumatic damage or oncological ablation of the distal radius in adults. Optimization of the bony contact, a stable bone fixation and alignment are the key points for a successful total wrist fusion. Long-term radiographical results and the overall functional outcome encourage to use this surgical option over other techniques. Abstract: Background: Total wrist fusion (TWF) is indicated for longstanding degenerative, posttraumatic and/or post-oncological conditions to provide pain relief and wrist stability at partial expense of wrist motion. Patients and Methods: A total of 11 consecutive patients who had completed TWF with Vascularized Fibula Graft (VFG) for massive distal radius defects were identified retrospectively from our center using inpatient records. We evaluated bone fusion times and long term functional outcomes following the procedure. Post-operative grip strength (GS) and prono-supination were objectively measured. The new Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to rate disability and symptoms; pre- and post- operative pain with the Visual Analog Scale ( VAS) was assessed. A literature review of the present studies about TWF with VFG was performed, with the aim of comparing long-term functional results of the surgical techniques so far reported in the English literature. Results: Our experience with TWF using VFG appeared slightly better than that found in the literature. The procedure was successful in all the cases, achieving bone union in 4, 8 months on average. Complication rate was 27, 2%, no flap loss was recorded. There were no wrist instability, deformation or dislocation; mean pronation/supination (P/S) was 57, 5°/61, 2° Average grip strength resulted 59% of the contralateral side. Mean recorded levels of visual analog scale (VAS) for pain postoperatively were 2, 32 ± 0, 792, which improved significantly from the pre-operatively value of 7, 90 ± 0, 79. Mean overall satisfaction was good and all the patients comfortably returned to normal activities. Conclusions: Wrist arthrodesis by means of VFG resulted to be an effective and reliable option in dealing with massive defects of distal radius with involvement of radio-carpal joint. Although the cohort analyzed is relatively small and definitive conclusions cannot be drawn, the long term radiographs and the overall functional outcomes encourage to use the described surgical option over other techniques, such as prosthetic replacement and non-vascularized bone grafts.