Implant removal combined with total wrist denervation for painful intra-articular distal radial malunions: a prospective study.

INTRODUCTION

The main aim of this study was to compare functional, pain and clinical outcomes between patients who underwent implant removal combined with total wrist denervation and patients who underwent implant removal alone for painful intra-articular malunion of fracture of the distal radius that was not amenable to osteotomy.

METHODS

This single-centre, prospective study included adult patients with painful intra-articular distal radial malunion non-amenable to osteotomy between 2022 and 2025. Patients were offered either implant removal combined with total wrist denervation (combined group) or isolated implant removal (isolated group). The primary endpoint was a comparison between groups of the postoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and visual analogue scale (VAS) pain scores at 1 year. The secondary outcomes were the comparison of the postoperative range of motion (ROM), grip strength and complications.

RESULTS

Overall, 35 patients were included. In the combined group, the QuickDASH and VAS scores were significantly improved at 1 year from 45.5 (IQR: 38.6 to 50.0) to 18.2 (IQR: 13.6 to 27.3) and from 4.8 (SD 1.1) to 1.6 (SD 1.4), respectively. In the isolated group, no significant improvement in the QuickDASH nor in VAS was found. At 1 year, patients in the combined group had a significantly lower QuickDASH score, lower VAS scores and improved grip strength compared with patients in the isolated group. There was no difference between the groups regarding ROM and number of complications.

CONCLUSION

The addition of total wrist denervation during implant removal appears to offer substantial symptom relief and improved function in this population.

LEVEL OF EVIDENCE: III.