PMC4342074_01
Preoperative appearance of wrist showing radiocarpal osteoarthritis.
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A 58-year-old paramedic presented with a stiff painful wrist following limited wrist fusion (LWF) with scaphoid retention (scaphocapitolunate fusion) and styloidectomy for a neglected scapholunate disassociation with stage 3 scapholunate advanced collapse (SLAC) and subsequent removal of hardware and open capsular release with significant radiocarpal osteoarthritis (Figure 1).
Ilizarov wrist distraction fixator assembly.
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A 2 mm distraction was immediately applied across the radiocarpal joint (Figure 2).
Maximal wrist distraction in frame.
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fig3
A further 5 mm distraction was applied over 12 days paying careful attention to neurological function (Figure 3).
Postdistraction radiograph showing improved radiocarpal appearance.
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At 20 weeks following frame removal final clinical range of motion was from 30-degree dorsiflexion to 70-degree palmar flexion with a 30-degree arc range of motion in radioulnar deviation and pain was significantly improved (Figures 4, 5, 6, and 7).
Postdistraction radiograph showing improved radiocarpal joint line.
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fig5
At 20 weeks following frame removal final clinical range of motion was from 30-degree dorsiflexion to 70-degree palmar flexion with a 30-degree arc range of motion in radioulnar deviation and pain was significantly improved (Figures 4, 5, 6, and 7).
Postdistraction wrist flexion.
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At 20 weeks following frame removal final clinical range of motion was from 30-degree dorsiflexion to 70-degree palmar flexion with a 30-degree arc range of motion in radioulnar deviation and pain was significantly improved (Figures 4, 5, 6, and 7).
Postdistraction wrist extension.
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At 20 weeks following frame removal final clinical range of motion was from 30-degree dorsiflexion to 70-degree palmar flexion with a 30-degree arc range of motion in radioulnar deviation and pain was significantly improved (Figures 4, 5, 6, and 7).
Wrist radiographs showing maintained joint space at 2 years.
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This was maintained at 12- and 24-month review without recurrence of symptoms or significant sclerosis (Figure 8).