Document Detail


Wrist fusion in posttraumatic brachial plexus palsy.
MedLine Citation:
PMID:  19952659     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Devastating brachial plexus injury with multiple root avulsions results in wrist instability, imbalance, and inability of patients to control the placement of their hand in space. In this study, results of wrist arthrodesis were analyzed in relation to factors such as age, severity score, and additional hand reanimation procedures. Indices of patient satisfaction were also measured using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires.
METHODS: Between January of 1978 and January of 2006, 97 patients with posttraumatic plexopathies underwent secondary procedures for hand reanimation. Sixty-one of these patients had wrist fusion. Arthrodesis was performed between the radius and third metacarpal using mainly a rigid plate; iliac bone graft was used in the majority of patients. Thirty-one patients underwent muscle transfers (45 free muscles) and 11 had tendon transfers in the wrist fusion group to enhance finger function. Patient self-assessment was carried out using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires.
RESULTS: All patients' wrists fused. Patients with free-muscle transfer for finger flexion and extension achieved superior muscle grading compared with patients without wrist fusion, but this was not significant. A total of 35 patients (57.37 percent) answered the questionnaires; 97.14 percent were satisfied with wrist stability and 88.57 percent reported that the procedure enhanced the overall upper limb function. The Disabilities of the Arm, Shoulder and Hand score was 59.14 +/- 12.9, which means moderate ability in daily activities.
CONCLUSIONS: Wrist fusion in patients with brachial plexus palsy is recommended as a complementary procedure, offering a stable, painless carpus, with improvement of overall upper limb function and appearance.
Authors:
Julia K Terzis; Antonia Barmpitsioti
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  124     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-02     Completed Date:  2010-01-11     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2027-39     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA 23501, USA. mrc@jkterzis.com
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic
Adult
Arthrodesis / methods*
Athletic Injuries / complications
Brachial Plexus Neuropathies / complications*,  diagnosis
Cohort Studies
Female
Follow-Up Studies
Hand Strength
Humans
Joint Instability / etiology,  surgery*
Male
Probability
Range of Motion, Articular / physiology*
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Tendon Transfer / methods
Treatment Outcome
Wounds and Injuries / complications*
Wounds, Gunshot / complications
Wrist Joint / physiopathology,  surgery*
Young Adult

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


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