Intercarpal arthrodesis: A systematic review

• Published in: Hand surgery and rehabilitation 2023-04, Vol.42 (2), p.93-102
• Main Authors: Athlani, Lionel, Cholley-Roulleau, M., Blum, A., Teixeira, P.A. Gondim, Dap, F.
• Format: Article
• Language: English
• Subjects: Arthrodesis - methods; Arthrodèses intracarpiennes; Arthrose; Carpal bones; Carpal Bones - surgery; Carpe; Carpus; Humans; Instabilité intracarpienne; Intercarpal arthrodesis; Intracarpal instability; Os du carpe; Osteoarthritis; Osteoarthritis - surgery; Poignet; Wrist; Wrist Joint - surgery
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2022.12.006

Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. III. Les arthrodèses intracarpiennes sont des solutions chirurgicales bien établies pour traiter diverses affections du carpe, tels que l'arthrose localisée, l'instabilité carpienne et la maladie de Kienböck. Il s’agit de chirurgies non conservatrices visant à obtenir une interface stable et congruente entre le radius et la rangée proximale du carpe, permettant de restaurer la fonction du poignet en réduisant les douleurs et en restaurant la force de préhension. Cependant, la perte d'amplitude articulaire du poignet est commune à toutes les arthrodèses intracarpiennes. Ces chirurgies sont connues pour donner en général de bons résultats, prévisibles et durables dans le temps. Pour optimiser ces résultats et minimiser les complications, en particulier la pseudarthrodèse, cette chirurgie peut nécessiter une courbe d'apprentissage. Une technique chirurgicale précise dans la préparation des surfaces osseuses, l'apport d'un greffon osseux en quantité suffisante et l'