Disorders of the Wrist, An Issue of Atlas of the Hand by Munir A. Shah, MD (Guest Editor)

By Munir A. Shah, MD (Guest Editor)

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Additional info for Disorders of the Wrist, An Issue of Atlas of the Hand Clinics (The Clinics: Orthopedics)

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Ruby [28] determined that the mean value for total range of wrist motion was 112(, whereas Linscheid [29] found it to be 150(. Brumfield and Champoux [30] demonstrated that an arc of wrist motion of 45(, from 10( flexion to 35( extension, is sufficient to accomplish most activities of daily living. Similarly Palmer [31] found that most activities are accomplished with only 5( flexion and 30( extension, 10( radial deviation and 15( ulnar deviation. 5% to 64% normal extension. In general, 4CF will allow enough motion to accomplish activities of daily living.

Indications Natural history studies of untreated scaphoid nonunion have indicated an increasing incidence of posttraumatic arthritis over time [16,17]. Ruby found 97% of patients who developed symptomatic scaphoid nonunion of more than 5-years duration progressed to arthritis [16]. Mack et al. showed that nearly all of their symptomatic nonunions progressed to early arthritis between 5 and 10 years and to generalized wrist arthritis by 20 years or more [17]. These findings have been used as justification to recommend surgical repair in virtually all patients with scaphoid nonunion due to the notion that if left untreated, arthritis will most likely develop [9].

Patients with fixed carpal collapse may have a significant risk for failure to achieve union such that other reconstructive options may need to be considered. Persistent pain has been attributed to malunion and has been improved with osteotomy [19]. Whether long-term uncorrected malalignment leads to arthrosis is unknown. Residual pain after union may otherwise be related to early Scaphoid nonunion advanced collapse wrist degenerative arthrosis unrecognized before scaphoid reconstruction [29]. In cases in which there is a question regarding the cartilage quality on the scaphoid and scaphoid fossa, arthroscopy can be performed as a staging diagnostic procedure.

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