eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Wrist Arthrodesis: Workup

Author: John J Walsh IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine
Coauthor(s): Mark Harper, MD, Staff Physician, Department of Orthopedic Surgery, Palmetto Richland Memorial Hospital
Contributor Information and Disclosures

Updated: Jun 25, 2008

Workup

Laboratory Studies

  • Prealbumin results should be greater than 18 for normal wound healing.
  • Absolute lymphocyte count should be greater than 1500 for normal wound healing.

Imaging Studies

  • Radiography
    • The standard 3 views of the wrist should identify the intracarpal and intercarpal joints with arthrosis. Radiographs should be examined for loss of joint intervals, subchondral reactive bone formation, subchondral cysts, and osteophyte formation. Particular attention should be paid to joints that are not going to be fused, such as the distal radioulnar joint and the thumb, index, ring, and small finger carpal-metacarpal joints. Pain from arthropathy in these joints is not affected by fusion and can lead to suboptimal outcome. Contralateral wrist radiography can be used to assess ulnar variance of the pathologic side. Standard radiography with 3 views of the wrist (ie, anteroposterior, lateral, and oblique) is necessary to determine which, and to what extent each, of the carpal articulations is involved.
    • Scaphoid view radiography should be obtained to determine whether an occult nonunion of the scaphoid exists.
    • The clenched-fist view stresses the intercarpal ligaments and may reveal an incompetent scapholunate ligament. Failure to address this problem at operation results in the failure of a scaphotrapezoid-trapezial (STT) fusion.
  • CT scanning of the wrist: On the rare occasion that plain radiography appears to be inadequate to identify all of the bony pathology accurately, CT scanning of the wrist can be helpful by exposing malalignment of bony columns and underlying arthropathy.

More on Wrist Arthrodesis

Overview: Wrist Arthrodesis
Workup: Wrist Arthrodesis
Treatment: Wrist Arthrodesis
Follow-up: Wrist Arthrodesis
Multimedia: Wrist Arthrodesis
References
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References

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Further Reading

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Keywords

wrist fusion, limited intercarpal arthrodesis, limited intercarpal fusion, subtotal arthrodesis, arthropathy of the wrist, wrist joint arthritis, bone-on-bone contact between the carpal bones and the distal radius, bony consolidation, midcarpal fusion

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Contributor Information and Disclosures

Author

John J Walsh IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine
John J Walsh IV, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Harper, MD, Staff Physician, Department of Orthopedic Surgery, Palmetto Richland Memorial Hospital
Mark Harper, MD is a member of the following medical societies: American Medical Association, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress, Southern Association for Oncology, Southern California Society of Gastroenterology, Southern Clinical Neurological Society, Southern Medical Association, Southern Orthopaedic Association, Southern Society for Pediatric Research, Southern Thoracic Surgical Association, Southwest Oncology Group, Southwest Pediatric Nephrology Study Group, Southwestern Association of Clinical Microbiology, Southwestern Surgical Congress, Special Operations Medical Association, State Medical Society of Wisconsin, Surgical Infection Society, Swedish Medical Association, Sydenham Society, Tennessee Medical Association, Tennessee Radiological Society, Teratology Society, Texas Medical Association, Texas Orthopaedic Association, Texas Pediatric Society, Texas Society of Plastic Surgeons, Trauma Association of Canada, Turkish Society for Parasitology, and US Virgin Islands Medical Society
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

N Ake Nystrom, MD, PhD, Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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