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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le lundi 3 décembre 2018
Doi : 10.1016/j.otsr.2018.08.020
Received : 1 August 2017 ;  accepted : 23 August 2018
Combined synovectomy and extensor carpi radialis longus transfer to realign and stabilise the rheumatoid wrist
 

Julien Berhouet a, b, , Steven Roulet a, Emilie Marteau a, Guillaume Bacle a, Nadhir Meghrani a, Jacky Laulan a
a Faculté de médecine de Tours, service d’orthopédie traumatologie, université François-Rabelais de Tours, CHRU de Trousseau, 1C, avenue de la République, 37170 Chambray-les-Tours, France 
b Équipe reconnaissance de forme et analyse de l’image, laboratoire d’informatique EA6300, école ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France 

Corresponding author. Service d’orthopédie traumatologie, université François-Rabelais de Tours, CHRU de Trousseau, 2A, avenue de la République, 37170 Chambray-les-Tours, France.Service d’orthopédie traumatologie, université François-Rabelais de Tours, CHRU de Trousseau2A, avenue de la RépubliqueChambray-les-Tours37170France
Abstract
Background

In patients with rheumatoid arthritis, the surgical treatment of wrist lesions relies on synovectomy combined with stabilisation and realignment of the carpal bones. The objective of this study was to evaluate the outcomes and define the indications of extensor carpi radialis longus (ECRL) transfer to the extensor carpi ulnaris (ECU) as described by Clayton and Ferlic.

Hypothesis

ECRL-to-ECU transfer combined with synovectomy can prevent the development and/or progression of rheumatoid deformities at the wrist.

Material and methods

A retrospective observational study was performed in 16 wrists. The following data were collected before and after surgery: pain, synovitis, range of motion, carpal height, ulnar translocation and radial deviation of the carpal bones, and Larsen's grade of the radio-carpal and mid-carpal joints.

Results

After a mean follow-up of 42.5 months after surgery, pain relief was noted in 14 cases and synovitis resolution in 10 cases. Mean mobility gains were 19.7° in extension and 5.7° in flexion. The radiographs showed a decrease in carpal height, whereas radial deviation and ulnar translocation were unchanged. No change was seen in the radio-carpal and mid-carpal joint lines. In the 3 wrists that required mid-carpal arthrodesis due to advanced disease before surgery, the radio-carpal joint line was unchanged and outcomes were the same as in the overall population.

Discussion

ECRL-to-ECU transfer combined with synovectomy provides pain relief and prevents radio-carpal destabilisation. The main indication of ECRL transfer is reducible radial deviation and ulnar translocation. ECRL is also indicated in combination with mid-carpal arthrodesis in the small minority of patients who have predominant mid-carpal involvement with a Larsen grade greater than 2.

Level of evidence

IV, retrospective observational study.

The full text of this article is available in PDF format.

Keywords : Rheumatoid wrist, Synovectomy, Carpal stabilisation, Extensor carpi radialis longus transfer




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