Effect of Triquetrum Bone Excision in Total Wrist Arthrodesis

Abstract

Abstract Background Ulnar impaction syndrome is one of the established causes of persistent postoperative discomfort and dissatisfaction following well-performed wrist arthrodesis. This syndrome however remains understudied, and it is unclear how often it occurs in patients. Moreover, while previous studies have led to several recommendations for the treatment of ulnocarpal impaction following arthrodesis surgery, many treatment options currently available may cause the pain in the wrist to be replaced by another type of pain. The aim of this study was to examine the results of excision of the triquetrum and its use as a graft during arthrodesis in patients who underwent total wrist arthrodesis due to end-stage wrist arthrosis and had ulnocarpal impaction causing limitation of pronation/supination of the forearm. Methods Three patients who underwent triquetrum excision were included in this study. Potential complications following surgical treatment and union status were evaluated, and Quick-DASH scores were assessed pre- and postoperatively. Results The patients were followed up for an average of 18 months. Before surgical treatment, the average motion for forearm supination in patients was 35 (30–40) degrees and the range for pronation was 45 (35–45) degrees. The mean Quick-DASH score before surgical treatment was 69.7 (63.6–75) degrees. In the controls, at the end of the follow-up period, the mean range of motion for forearm supination was 81.6 (80–85) degrees and the mean range for pronation was 85 (80–90) degrees. The mean QuickDASH score was 5.3 (2,3–9.1). No major complication was observed. Conclusions Based on our findings, we recommend that in cases with positive ulnar variance, no arthrosis in the distal radioulnar joint, painful and preoperative or intraoperative limited pronation/supination, triquetrum excision be routinely performed with total wrist arthrodesis.