Management of the spastic wrist: shortening wrist arthrodesis versus radial extensors tenodesis
Prof Bertrand COULETa, Dr Iskander DJERBIa, Dr Flavia Oana COROIANa, Prof Isabelle LAFFONTa
a CHRU Lapeyronie
Background:Wrist stabilization for patient with spastic hand is an important issue with consequences on hygiene cares and pain but also on functional improvement of the hand grip.
The purpose of this study was the comparison of two wrist stabilization methods.
Methods: We included 43 adults, 14 women and 29 men, with a mean age of 50.4 years (14-68 years), with a severely spastic hand who underwent wrist stabilization, by tenodesis arthrodesis in 23 cases and shortenning wrist arthrodesis in 20 cases, with an averaged follow-up of 67 months.
The assessment criteria were: correction of wrist and fingers deformities, hygiene and pain improvement, the Fugl Meyer (FM) score and the House grasp score.
Results: The results showed a good correction of the wrist deformity, 96° for arthrodesis and 75° for tenodesis (p = 0.07), a good correction of fingers deformity with a correction of the palmar digital angle of 101,3° for tenodesis and 93.2° for arthrodesis (p = 0.11). If both techniques are so similar in terms of hygiene (VAS = 8.8) and post-operative pain (VAS = 0.3 for tenodesis, 1.5 for arthrodesis, p = 0.12), there is however a difference in favour of wrist arthrodesis for the FM score both proximal subscore (1.9 vs 0.5, p = 0.04) and distal subscore (1.3 vs 0.3, p = 0.04) and the House grasp score (1.4 vs 0.8, p = 0.19).
Conclusions: The results of arthrodesis did change our wrist stabilization technique because it presents several advantages: no conflict with the extensor tendons, no need to remove hardware when using dorsal plates, a systematic wrist correction with extension of 20°, no loss of correction by tenodesis dropping, a better functional gain for grasping and proximal and distal function.
Keywords : spastic wirst, arthrodesis, radial extensor tenodesis