SEARCH · PubMed Health

Results for “ARTHRODESIS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed1992

Arthrodesis of the ankle in patients who have rheumatoid arthritis.

We reviewed thirty-two arthrodeses of the ankle in twenty-six patients who had rheumatoid arthritis. In seventeen patients (eighteen ankles), a compression arthrodesis was done and external fixation was used. In eight patients (twelve ankles), we used internal fixation with 6.5-millimeter cancellous-bone screws. In the remaining patient, an arthrodesis with external fixation was done in one ankle and internal fixation was used in the other ankle; data for the appropriate ankle are included in each group. The patients were followed for an average of thirty-three months. The two groups were comparable with respect to age, sex, preoperative medications, and severity of disease. The average time to fusion was nineteen weeks in the compression arthrodesis group and seventeen weeks in the internal fixation group. Of the nineteen ankles that had a compression arthrodesis, four failed to fuse; all of the failures were associated with infection. Infection developed in two additional patients, there was malposition of the fusion in three patients, and neurapraxia developed in three patients. Of the thirteen ankles that had internal fixation, three ankles failed to fuse; one of the failures was associated with infection. Infection developed in one additional ankle. In two patients, the ankle fused in excessive valgus. Comparison of the two groups revealed comparable rates of fusion: fusion occurred in fifteen of the nineteen ankles in the group that had compression arthrodesis and in ten of the thirteen ankles in the group that had internal fixation. The method of arthrodesis did not affect the time to fusion or the rate of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Comparable energy expenditure after arthrodesis of the hip and ankle.

The energy expenditure and gait characteristics of eleven subjects who had a unilateral arthrodesis of the hip and ten subjects who had a unilateral arthrodesis of the ankle were measured during a twenty-minute walking trial. Oxygen consumption was determined and heart rate, respiratory rate, and step frequency were monitored. The average walking speed for both groups was sixty-seven meters per minute, which is 84 per cent of normal gait velocity. After an arthrodesis of the ankle, the average rate of oxygen consumption was 12.0 milliliters per kilogram of body weight per meter, which is 3 per cent more than normal. The oxygen cost averaged 0.166 milliliter per kilogram per meter, resulting in a gait efficiency of 90 per cent. After arthrodesis of the hip, the mean rate of oxygen consumption was 14.9 milliliters per kilogram of body weight per meter, which is 32 per cent greater than normal. The oxygen cost, 0.223 milliliter per kilogram per meter, represented a gait efficiency of 53 per cent. The physiological energy expenditure by the subject after an arthrodesis of the hip was found to be significantly greater than after an arthrodesis of the ankle and was more than that reported previously after a total hip arthroplasty for unilateral degenerative disease.

Adult↗

PubMed1994

Partial radiocarpal arthrodesis.

Eight patients underwent partial radiocarpal arthrodesis for various wrist disorders. There were 5 men and 3 women, whose age at operation ranged from 33 to 59 years with an average of 44 years. The indications for operation included post-traumatic changes secondary to distal radius fracture in 5 cases, Kienböck's disease in 1, Madelung's deformity in 1, and rheumatoid arthritis in 1. Arthrodesis was performed at the radiolunate joint in 5 cases, and at the radioscapholunate joint in 3 cases. In all cases, bone union was obtained within 3 months postoperatively. Postoperative wrist pain disappeared in 6 cases, and decreased in 2 cases. The average postoperative flexion-extension arc of motion was 35 degrees in the radioscapholunate arthrodesis group, and 85 degrees in the radiolunate arthrodesis group. The postoperative grip strength compared with the unaffected hand averaged 51% in the radioscapholunate arthrodesis group, and 68% in the radiolunate arthrodesis group. One patient showed a deterioration in the osteoarthritic change in the midcarpal joint.

Adult↗

PubMed1995

[Tibiotarsal arthrodesis: value of external fixator associated with in situ cancellous bone graft. Initial results apropos of 18 cases].

Tibio-talar arthrodesis poses some problems and the most frequent are non-union and varus malalignment of the ankle joint. The aim of this report was to present a new technique of ankle joint arthrodesis. The principles of this procedure are as follows: firstly, the external fixation (A.L.J.) is framed, secondly, perpendicular cuts are made in the tibial plafond and talus through an anterior longitudinal approach; and thirdly, the gap is filled with cancellous bone graft which is taken preferably on the iliac crest. If the back-foot is not correctly lined up preoperatively, the external device is framed in two steps: the first step consists in putting the pins. Then perpendicular cuts are made, and the back-foot is correctly lined up using calcaneal pins. The second step consists in connecting tibial pins and foot pins using union-rods. The last step of the procedure is to fill the gap with cancellous bone graft. The external fixation device is removed after 45 days and a shortleg walking cast is put for 45 days. Between 1981 and 1992, 18 arthrodesis were performed on various diagnosis: 9 post-traumatic tibio-talar osteoarthritis, 4 residual neurologic diseases, 2 rheumatoid arthritis and 3 recent post-traumatic lesions. There were 17 patients (one bilateral case), 4 females and 13 males; the middle age at the time of operation was 44.5 years (20 to 60) and there were 10 right ankles and 8 left. The tibio-talar arthrodesis was performed alone in 14 cases, but it was associated with a talo-calcaneus arthrodesis in 4 cases. The after care was without complications except 3 pins infection which cured with antibiotics. All the cases had a good bony union within 3 to 6 months and the orientation of the backfoot was always satisfactory without varus malalignment. All the patients could put one's shoes without having recourse to orthopaedic shoes. In conclusion, this operative procedure seems to minimize the problems and pittfalls of the ankle arthrodesis.

Adult↗

PubMed1996

[Arthrodesis of the shoulder for post-traumatic palsy of the brachial plexus. Analysis of a series of 18 cases].

PURPOSE OF THE STUDY: In case of severe traction injuries of the supraclavicular brachial plexus in adult, the functional results of direct shoulder nerve repair are less predictable than those of the elbow. Furthermore, the surgical management of the remaining flail shoulder is still controversial. The post-operative results and the indication for shoulder arthrodesis are evaluated in this study. MATERIAL AND METHODS: Between October 1978 and January 1994, 18 gleno-humeral arthrodesis were performed on 18 patients for paralytic shoulder following brachial plexus injury. The average age at the time of operation was 25 years. A C5C6 lesion was present in 2 patients, a C5C6C7 lesion in 8 patients and a C5 to T1 lesion in the remaining 8 patients. Seven patients had a suprascapular nerve reinnervation failure. All these 18 patients recovered an active elbow flexion spontaneously or following direct nerve repair, tendon or free muscle transfer. The average delay between nerve repair and arthrodesis was 2 years and 4 months. For fixation, we always used internal fixation by screws, combined to an external fixator device in 10 cases. RESULTS: 16 patients were reviewed with an average follow-up of 6 years and 10 months (min. 6 months, max. 15 years and 8 months). Two types of complications occurred: 2 cases of gleno-humeral non-union requiring revision with bone-grafting, and 3 humeral fractures in the first 6 months after arthrodesis. The study of the arthrodesis position showed an average abduction of 25 degrees, an average flexion of 18 degrees, an average internal rotation of 22 degrees. The average motion values are 60 degrees of abduction and flexion, 14 degrees of extension, 0 degree of external rotation and 48 degrees of internal rotation. The range of motion depends closely on scapulo-thoracic muscles strength, especially the serratus anterior muscle. A flail hand primarily influences the subjective result. 14 of the 16 patients could easily reach their mouth. The average muscle shoulder strength, evaluated with the Isobex device, is 11 kg for flexion and abduction, 9 kg for adduction, 8 kg for internal rotation and 4 kg for external rotation. DISCUSSION AND CONCLUSION: Gleno-humeral arthrodesis is a reliable method for restoring shoulder function in case of brachial plexus sequellae lesion, giving more strength, but less external rotation than shoulder nerve repair.

Adolescent↗

PubMed1997

Subtalar arthrodesis for subtalar arthritis.

Primary subtalar arthritis is not common except in cases of generalized arthritis such as rheumatoid arthritis. The majority of subtalar arthritis results from intraarticular calcaneal fractures. Arthrodesis seems to be the only way to solve this problem. Thirteen patients (15 feet) were treated with subtalar arthrodesis at KMCH. Preoperative diagnosis included 13 feet with traumatic arthritis secondary to a calcaneal fracture, one foot with rheumatoid arthritis and one foot with primary osteoarthritis. The mean follow up period was 24.9 months. Lateral approach without fibular osteotomy was done with decompression if there was entrapment syndrome and the arthrodesis were accomplished with use of staples for internal fixation. Eleven (85%) of the patients were satisfied with the results. Objectively, the results were excellent after 11 arthrodesis (73%), good or fair after three (20%), and poor after one (7%). There was no nonunion. Complications occurred in 1 patient who developed superficial wound infection, and in 1 patient with staple loosening. Though there was no case of nonunion, the fusion time was rather long. This might have been due to the fixation method because staples can not provide compression force which accelerates union. We believe subtalar arthrodesis is appropriate for isolated subtalar arthritis unless there are associated talonavicular or calcaneocuboid arthritis in which case triple arthrodesis will be more appropriate.

Adult↗

PubMed2006

Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis.

OBJECTIVE: Cervical spine deformities are well-known complications of RA. A 5- to 20-year follow-up of 51 consecutive rheumatoid patients who underwent posterior cervical arthrodesis is presented to evaluate the recurrence of instability and need for further surgery. METHODS: We conducted a retrospective review of the clinical features of 11 men and 40 women with an established diagnosis of RA and associated cervical deformities who underwent cervical spine surgery at the Mayo Clinic (Rochester, MN) between 1979 and 1990. Their mean age was 61 +/- 10 years (SD), and their duration of RA averaged 21 +/- 8.9 years (SD). There were 22 patients who presented with myelopathy, 7 with radiculopathy, and 22 with instability/neck pain. There were 33 patients with AAS, 2 with SMO process into the foramen magnum, 8 with SAS, and 8 with combinations of these. Preoperative reduction was followed by decompression and fusion using wiring techniques and autologous bone graft. Postoperative halo orthosis was provided for at least 3 months. The mean follow-up was 8.3 +/- 6 years (SD). RESULTS: There were 31 patients (61%) who underwent atlantoaxial arthrodesis, 17 patients (33%) who underwent subaxial, and 3 patients (6%) who underwent occipitocervical arthrodesis. During follow-up, 39% (13/33) of patients with AAS developed nonsymptomatic (6) or symptomatic/unstable (7) SASs subsequent to C1-C2 fusion. The latter 7 patients (21%) subsequently required extension of their arthrodesis. Adjacent segment disease was most common at the C3-C4 interspace after atlantoaxial fusion in 62% (8/13). Among the 8 patients who underwent isolated cervical fusion for SAS, 1 patient (1/8, 12%) developed adjacent instability after a fall and required extension of the previous fusion. No secondary procedure was required for the 6 patients initially stabilized by C1-(C6-T1) fusions for combinations of AAS + SAS. None of the patients initially treated by C1-C2 arthrodesis for AAS progressed to SMO. CONCLUSIONS: The incidence of subaxial instability in patients with rheumatoid disease who underwent cervical arthrodesis may be higher than previously reported, indicating the need for continued follow-up in these patients. Adjacent segment disease may be most common at the C3-C4 level following atlantoaxial fusion. Early stabilization of the C1-C2 complex in the patients with AAS may potentially prevent progression of SMO.

Aged↗

PubMed1994

The treatment of lumbar spinal pain syndromes diagnosed by discography. Lumbar arthrodesis.

STUDY DESIGN: This retrospective review of patients whose discogenic pain syndromes were treated by lumbar arthrodesis was designed to examine the clinical efficacy of this diagnostic modality and analyze possible confounding variables. OBJECTIVES: Clinical outcome was examined with respect to status of the arthrodesis, discographic diagnosis, and demographic variables. SUMMARY OF BACKGROUND DATA: Discography continues to be a controversial diagnostic technique for spinal pain syndromes. The morphologic information provided by discography is well known. However, disagreement exists concerning the clinical utility of the pain provoked by this modality. METHODS: Forty-eight patients were included in this study. In all patients, the chief complaint was low back pain. In all patients, the definitive diagnostic technique was lumbar discography followed by computerized tomographic scanning. All patients underwent lumbar arthrodesis. Data were collected in four categories: 1) demographic characteristics, 2) physical findings, 3) results of diagnostic studies, and 4) characteristics of surgical procedures. Data from these categories were studied with respect to clinical rating and status of the arthrodesis. RESULTS: Overall, 46% were judged to have a satisfactory clinical outcome at final follow-up. Forty-eight percent were judged to have a solid arthrodesis. CONCLUSIONS: Based on the results of this study, it appears that discogenic pain syndromes can be treated by arthrodesis.

Adult↗

PubMedDate not supplied

Cervical spine range of motion in children with posterior occipitocervical arthrodesis.

This prospective study compared cervical spine (c-spine) range of motion (ROM) in children with posterior occipitocervical arthrodesis to a control group of healthy participants. Cervical spine ROM is likely be altered after fusion. However, the extent to which posterior occipitocervical arthrodesis affects ROM in the c-spine of children has not yet been established. Furthermore, there are conflicting reports on this topic in the literature. To the best of our knowledge, no study has specifically addressed the effect of posterior occipitocervical arthrodesis on c-spine ROM in children. In this study, c-spine ROM of 15 patients who underwent posterior occipitocervical arthrodesis for upper c-spine instability was evaluated and compared with 15 healthy age-matched children. We used the CROM Goniometer (Performance Attainment Associates, St Paul, MN) to measure c-spine flexion, extension, lateral bending, and axial rotation. Student t test was used to evaluate the study results. Cervical spine ROM was significantly decreased in children with posterior occipitocervical arthrodesis compared with controls (P < 0.05). Axial rotation was the most affected movement, decreasing by an average of 30 degrees in each direction, flexion and extension each decreased by 13 degrees, and lateral bending decreased by approximately 7 degrees in each direction. Posterior occipitocervical arthrodesis decreases c-spine ROM in children compared with healthy controls.

Adolescent↗

PubMed1993

Spinal mobility and deformity after Harrington rod stabilization and limited arthrodesis of thoracolumbar fractures.

The results were reviewed for thirty patients in whom a thoracolumbar fracture had been treated with a Harrington rod placed three segments cephalad and two or three segments caudad to the injured vertebra and a short arthrodesis with removal of the Harrington rod after at least twelve months. The patients were evaluated with clinical examinations, lateral radiographs made with the spine in flexion and extension, and questionnaires at a median of thirty-two months after the stabilization. All of the arthrodeses were successful. The twenty patients who had a burst or compression fracture and who had posterior instrumentation lost only an average of 9 degrees of sagittal correction before attaining a solid fusion. For all thirty patients, the average motion in the sagittal plane at the vertebrae that had been spanned by the Harrington rod but not included in the arthrodesis ranged from 9 degrees at the third and fourth lumbar level to 2 degrees at the eighth and ninth thoracic level. The average total motion between five vertebrae that had been spanned by the rod but did not have an arthrodesis was 24 degrees; between four vertebrae, 23 degrees; and between three vertebrae, 19 degrees. In this series of thoracolumbar fractures treated with a longer Harrington rod than needed to span the level of the arthrodesis and a short arthrodesis, there was a documented return of motion to segments that had been previously spanned by the instrumentation but not included in the arthrodesis and good or excellent functional results over-all.

Adolescent↗

PubMed1980

The historical evolution of arthrodesis of the foot.

Arthrodesis is the term coined by Albert for the operation whose purpose is to induce ankylosis of a joint by denuding it of cartilage. Whereas arthrodesis of the foot was initially used for paralytic conditions, its use has progressively widened. Numerous modifications of the original procedure have been developed, and with increasing experience the indications for each type of arthrodesis has been more clearly defined. Basic principles have emerged: a) To apply arthrodesis of the foot to stabilise joints, to correct deformity, to eliminate joint disease and pain: b) To limit arthrodesis to the minimum number of joints; c) To denude the articular surfaces congruently in order to enhance ankylosis; d) To add, where indicated, either bone grafting to enhance fusion or tendon transfer to prevent recurrent deformity.

Arthrodesis↗

PubMed2003

[Intramedullary nailing in tibiotalocalcaneal arthrodesis].

Tibiotalcalcaneal arthrodesis is still the treatment of choice for disabling arthrosis of the upper and lower ankle joint, although replacement of the upper ankle joint is widely accepted. Numerous techniques have been described, with increasing use of internal fixation and compression. In 20 patients tibiotalocalcaneal arthrodesis was performed using a retrograde femur nail inserted through the heel, whereas in 20 patients combined arthrodesis of the upper and lower ankle joint was performed using a distal tibia nail through an anterograde approach. Patients were evaluated in a standardized examination using criteria of SF 36 focussing on approach, osseous consolidation, and quality of life.Both techniques demonstrated good results: bony consolidation was achieved after follow-up time of 19 months in 85% of the anterograde group and 95% of the retrograde group. In 78% pain was reduced effectively using the intramedullary nail arthrodesis and quality of life improved drastically. In four cases pseudarthrosis occurred, two implant failures were reported, and there were two infections. Using the anterograde as well as the plantar approach, tibiotalocalcaneal intramedullary nail arthrodesis is an appropriate technique. In this study both groups demonstrated good results regarding bony consolidation, reduction of pain, and improved quality of life. Advantage of the retrograde technique is the noninvasiveness of the proximal tibia. Heel pain or plantar infections were not observed. We see limits of the presented technique in severe malalignment and septic history of the patient.

Adult↗

PubMed2005

[Force distribution in the wrist following scaphotrapeziotrapezoid arthrodesis].

Scaphotrapeziotrapezoid (STT) arthrodesis has been proposed to stabilise the radial column and to redirect the load away from the lunate. Midterm effects on force transmission are still unclear. Six patients who were treated with triscaphe arthrodesis were examined after an average of 5 years using CT osteoabsorptiometry of both wrists. STT arthrodesis had been performed in four cases with Kienböck's disease type IIIb and in two cases of scaphotrapeziotrapezoid arthritis. At all contralateral wrists peak mineralisations were found beyond the lunate fossa and in the scaphoid fossa of the distal radius. At the side with STT arthrodesis there was only one peak. In five cases this density maximum was beyond the scaphoid fossa and in one case half beyond the lunate and half beyond the scaphoid fossa. Triscaphe arthrodesis allows load transmission from the lunate to the radial column.

Arthritis↗

PubMed2000

[Results of arthrodesis after knee prosthesis infection. Special reference to quality of life].

AIM OF THE STUDY: In case of extensive bone loss arthrodesis can be more favourable than one or two stage revisions with new arthroplasties after infected implants. MATERIAL AND METHODS: 19 patients with arthrodesis of the knee joint because of infected arthroplasty were clinical-radiological examined after 5.2 years. The quality of life was measured with the SF-36 score. The average age at the arthroplasty implantation was 63.8 years. 5 patients had constrained prostheses, 14 bicondylar sledge prostheses. DISCUSSION: The average results in health orientated life quality of patients with arthrodesis in case of infected arthroplasty were lower than in control groups but singular aspects scored higher. After the arthrodesis some patients increased their levels compared to the period with arthroplasty. CLINICAL RELEVANCE: The fear of loss of quality after arthrodesis of the knee joint can not be supported. Some results were not better with arthroplasty or without an operation.

Aged↗

PubMed2000

[Press-fit bone dowel arthrodesis of the ankle or the subtalar joint using a diamond bone cutting system. Surgical technique and initial results in 10 patients].

Arthrodesis of the ankle (AA) or the subtalar joint (AST) is still a necessary treatment in case of painful posttraumatic arthrosis or paresis of the muscles after compartment syndrome. Today the alloplastic ankle joint replacement does not satisfy. Many treatments of arthrodesis with minimal or extended resection of the joint surface with or without bone transplantation are described in literature. We present in detail a new developed technique of press-fit dowel arthrodesis (KDA) for the ankle and subtalar joint. After adjustment of the joint position and retention with Kirschner wires the surface of both sides of the joint surface and underlying bone is removed by a cannulated diamond bone cutting device. Dowels from the anterior iliac crest are impacted in the cutted joint defect. The dowels are 1/10 mm bigger in dimension than the primary defect in the joint surface. The surgery will be completed with a compression screw osteosynthesis, at the ankle joint transarticular through the lateral and medial malleolus, at the subtalar joint from plantar. Ten patients have treated by press-fit-KDA (female 2, male 8; AA 7, 33.6 +/- 9 y; AST 3.38 +/- 10.9 y). The indication for KDA was in nine cases a severe posttraumatic arthrosis, in one case the paretic malfunction after compartment syndrome. The arthrodesis were clinically and radiologically consolidated after 8.2 +/- 1.9 weeks. At this time the patients showed no symptoms and were fully mobilised with complete weight-bearing. The advantages of KDA: preservation of the outline of joint and hindfoot, preservation of length of the leg and outline of iliac crest, no risk for the soft tissue, quick consolidation of the arthrodesis, no need of external fixation. The technique is also suitable for other indications as presented.

Adult↗

PubMed2005

Arthrodesis of the knee after failed infected total knee arthroplasty.

Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.

Aged↗

PubMed2004

[Adaptive patterns of the rheumatoid wrist after radiolunate arthrodesis].

OBJECTIVE: The aim of this study was the analysis of long-term carpal changes after radiolunate arthrodesis. METHODS: Pre- and postoperative X-rays of 91 wrists in 78 patients with rheumatoid arthritis, who were treated for carpal instability with a radiolunate arthrodesis, were examined concerning the midcarpal joint and the Larsen grade. The mean follow-up was 60 months. RESULTS: After radiolunate arthrodesis the midcarpal joint space remained unchanged in 28%. In 35% secondary arthritis and in 37% further arthritic destruction occurred. The mean Larsen grade increased from 3.2 to 3.8. Six wrists needed complete arthrodesis 25 to 87 months after the primary procedure and one was treated by total wrist replacement. Adaptive changes of the carpus during progressive disease and in secondary arthritis were recognized. Three types of joint lines could be identified: in 35% of the wrists a "perilunar", in 22% a "radio-midcarpal" and in 3% a purely "midcarpal" joint line. In 40% no specific joint line could be identified. CONCLUSION: After radiolunate arthrodesis the carpus remains unchanged in the long run in nearly a third of cases. But even if secondary arthritis or further arthritic destruction occurs as in the remaining cases, the carpus shows an amazing capacity for adaptation. A new intracarpal joint line may develop or the midcarpal joint re-establishes itself.

Arthritis, Rheumatoid↗

PubMed1993

Lunotriquetral arthrodesis.

Lunotriquetral arthrodesis has been recommended for the treatment of disabling pain at the lunotriquetral joint after more conservative measures have failed. We retrospectively analyzed a series of 22 patients treated with a lunotriquetral arthrodesis for presence of fusion, method of fixation, duration of immobilization, carpal alignment, pain relief, and ability to return to work. Fixation with a Herbert screw supplemented with a Kirschner wire (K-wire) was superior to fixation with K-wires alone. Immobilization longer than 6 weeks was superior to immobilization less than 6 weeks. Combined use of a Herbert screw supplemented with a K-wire and immobilization longer than 6 weeks resulted in union in all patients, even when performed for nonunion after a prior attempted arthrodesis. Pain was improved in all patients; all patients who previously were working returned to work. Routine posteroanterior and lateral x-ray films often failed to adequately profile the arthrodesis site. We recommend using a Herbert screw supplemented with a K-wire for lunotriquetral arthrodesis and keeping the patient in a cast until fusion is documented, usually at least 8 weeks. Fluoroscopic spot views or tomograms are recommended to demonstrate bone fusion.

Adult↗