Document Detail

Three-dimensional kinematics of the rheumatoid wrist after partial arthrodesis.
MedLine Citation:
PMID:  19723995     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Partial arthrodesis of the wrist, such as radiolunate and radioscapholunate arthrodesis, is intuitively more appealing for the treatment of the rheumatoid wrist than total arthrodesis is because it preserves some motion. However, wrist kinematics after partial arthrodesis are incompletely understood. The purpose of the present study was to evaluate the kinematics of the radiocarpal and midcarpal joints of rheumatoid wrists with use of three-dimensional computed tomography before and after partial arthrodesis. METHODS: We selected ten wrists that were affected by rheumatoid arthritis in which the radiolunate joint was severely damaged but the midcarpal joint congruities were relatively well preserved. Six radiolunate and four radioscapholunate arthrodeses were then performed, with preservation of the joint congruity between the scaphoid, lunate, and capitate. We acquired in vivo three-dimensional kinematic data during wrist flexion-extension preoperatively and postoperatively with use of computed tomography and a markerless bone-registration technique. Postoperative midcarpal joint congruity and range of motion were compared with preoperative values. RESULTS: The mean range of global wrist motion was 48 degrees +/- 21 degrees after radiolunate arthrodesis and 47 degrees +/- 14 degrees after radioscapholunate arthrodesis. Midcarpal joint congruities and motion between the scaphoid, lunate, and capitate were well preserved in all ten wrists. The postoperative range of capitate motion relative to the lunate was 109% of the preoperative value after radiolunate arthrodesis and 88% after radioscapholunate arthrodesis. The directions of capitate motion relative to the lunate after both types of partial arthrodesis were significantly more oblique than before the arthrodeses, changing from radiodorsal to ulnopalmar along the so-called dart-throwing motion plane (p < 0.05). CONCLUSIONS: The results of this kinematic analysis, which showed that midcarpal motion occurred in the dart-throwing motion plane, may support the use of radiolunate and radioscapholunate arthrodeses as an alternative to total wrist arthrodesis in patients with symptomatic rheumatoid arthritis of the wrist.
Sayuri Arimitsu; Tsuyoshi Murase; Jun Hashimoto; Hideki Yoshikawa; Kazuomi Sugamoto; Hisao Moritomo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  91     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-02     Completed Date:  2009-09-22     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2180-7     Citation Subset:  AIM; IM    
Department of Orthopaedic Surgery, Osaka University, Osaka, Japan.
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MeSH Terms
Arthritis, Rheumatoid / radiography,  surgery
Carpal Joints / physiopathology*,  radiography*
Imaging, Three-Dimensional
Middle Aged
Range of Motion, Articular
Tomography, X-Ray Computed
Wrist Joint / physiopathology*,  radiography*,  surgery
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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