Ulnoradial - metacarpal reconstruction for emergency one-stage procedure in complicated wrist amputation.

Abstract

Background: Complicated wrist amputation caused by severe trauma poses a real challenge for orthopedic and hand surgeons. This study aimed to evaluate a procedure of ulnoradial-metacarpal reconstruction as a rescue option in this challenging situation.

Methods: In total, 12 patients with complicated wrist amputation induced by serious injury were selected from 2015 to 2020 and followed up for 1∼6 years at a level 1 trauma center. All patients underwent initial treatment in the Emergency Department followed by transfer to the main operating theater for emergency ulnoradial-metacarpal reconstruction. Patient demographics, surgical techniques, clinical outcomes, and complications were also retrieved from medical records. Functional outcomes were assessed with Disabilities of Arm, Shoulder and Hand score (DASH) and Mayo Wrist Score (MWS). Descriptive statistics were used to calculate, including frequencies for categorial variables and mean values and ranges for continuous variables.

Results: The mean age of patients was 49.3 years (ranging from 41 to 61 years), with ten males and two females. The mean time to union was 4.8 months; 11 patients had a complete union. There was one case of nonunion due to bone resorption resulting from inadequate blood supply and smoking. Compared with the contralateral limb, the total active motion of the hand was 25% (ranging from 17 to 38%), and grip strength was 7% (ranging from 0 to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6 mm (ranging from 8 to 12 mm). All mean outcome scores indicated moderate disability, including disabilities of Arm, Shoulder, and Hand (12; ranging from 4 to 27). Based on Mayo Wrist Score, all patients were loss of wrist function forever. The majority of patients were satisfied with the hand function after recovery.

Conclusion: Despite all patients experiencing significant impairments in their overall hand function, ulnoradial-metacarpal fusion presents a viable option for hand replantation in instances where the carpus has been irreparably damaged.

Type of study/level of evidence: Therapeutic IV.