Radioscapholunate Fusion Using a Volarly Placed Plate for Treating Post-Traumatic Radiocarpal Joint Arthritis after a Distal Radius Fracture - A Single-Centre Prospective Study.

Background

There is currently no consensus regarding optimal treatment strategies for treating radiocarpal arthritis. The purpose of this prospective study was to compare preoperative and postoperative wrist range of motion (ROM), residual pain, grip and pinch strength, functional results and fusion rates after radioscapholunate (RSL) fusion using a volarly placed plate.

Methods

This single-centre prospective study was conducted from January 2022 to December 2024. This study included nine patients (six males and three females) with post-traumatic arthritis after a distal radius fracture who underwent RSL fusion using a volarly placed plate. Pre- and postoperative functional results were measured using pinch strength, grip power, Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue pain score (VAS).

Results

Fusion was achieved for all patients with no complications. Significant improvements in grip and pinch strength were noted from 6 months onwards (p < 0.05), with patients having 91% recovery of their grip strength as compared to their healthy hand. Fusion was also able to provide significant pain relief with functional improvements of upper extremities (preoperative: 74.3 ± 11.3; postoperative 1 year: 5.0 ± 4.7) from 3 months postoperatively (p < 0.05). Regarding wrist ROM, significant improvements in wrist pronation, supination were noted from 3 months preoperatively (p < 0.05). Degree of radial (preoperative: 8.9° ± 3.5°; 3 months: 5.0° ± 4.4°; 6 months: 9.6° ± 2.9°; 1 year: 11.2° ± 2.3°) and ulnar deviation had gradual improvements from 6 months onwards. No significant differences between preoperative and postoperative flexion and extension were noted.

Conclusion

RSL fusion using a volarly placed plate is a reliable surgical option for managing post-traumatic radiocarpal joint arthritis following a distal radius fracture with good clinical, functional and radiological outcomes. Level of Evidence: Level III (Therapeutic).