Results of wrist hemiarthroplasty for comminuted distal radius fractures in independent elderly people: A retrospective study on eleven patients.

The comminuted distal radius fractures among elderly people are usually linked to osteoporosis, and repairing them in this context is a therapeutical challenge. Several teams have reported good results of radius resurfacing. The goal of our study was to evaluate the usability of the wrist in a new series of patients after surgery. We performed a monocentric retrospective study on the data of the medical files. All the included patients were older than 65 years and received a wrist hemiarthroplasty according to the criteria that have been established by the in charge medical team. Eleven patients have been included, their average age was 80.4 years old, and the average follow-up was 18.3 months. The average QuickDASH Score was 59 (27-95). The Visual Analogue Scale for pain was in average 3.8/10 and the average mobility was: flexion 36° (12-50), extension 27° (12-50), radial deviation 15° (12-15), ulnar deviation 26° (12-40), pronation-supination range of motion 164° (150-170). The average measured strength was 44% (16-72%) of the strength of the unaffected hand. Our results are rather modest, probably because of insufficient follow-up and very severe fractures. Furthermore, the implant that has been used does not take into account the distal radioulnar joint. Another bound of this treatment is the complexity of surgical revision in case of bad result. So far, hemiarthroplasty cannot be considered as the standard treatment for complex fractures of the distal radius.

Results of Toccata® resurfacing PIP joint arthroplasty. A series of 32 cases at a mean follow-up of 5.9 years.

The objective of this study was to evaluate the long-term results of proximal interphalangeal (PIP) resurfacing arthroplasty for treating osteoarthritis: the PIP Toccata implant®. This was a retrospective study of 32 out of 33 PIP arthroplasty cases performed with a dorsolateral or a Chamay approach by two surgeons after a minimum follow-up of 24 months. Patients were reviewed using a standardized assessment of pain, function, mobility and radiological changes. The average follow-up was 5.9 years. The mean active range of motion was 67° (15-95). Radiographic analysis found osteointegration of the implant in all patients except one, in whom distal migration had no clinical consequence. Heterotopic ossifications (HO) developed in 10 of the 20 cases where the implant was inserted through a lateral approach. Intra-articular bone debris was identified in the first postoperative X-ray in most of these cases. The presence of HO was significantly correlated with decreased range of motion (P<0.05). Six patients required surgical revision and two needed implant removal and arthrodesis. Our results are comparable to other published studies of PIP resurfacing arthroplasty. It is important to remove all bone debris when using the dorsolateral approach. The PIP Toccata® implant is a reliable solution for treating PIP osteoarthritis but this arthroplasty procedure is demanding.

Treatment of comminuted distal radius fractures by resurfacing prosthesis in elderly patients.

In elderly patients, distal radius fractures are often associated with osteoporotic bone. Under these conditions, anatomic resurfacing implants may provide satisfactory results in terms of range of motion, pain and function. Between July 2009 and January 2012, eight elderly patients were treated with the SOPHIA™ implant at our hand surgery department. Inclusion criteria were isolated comminuted distal radius AO type C2 fractures in patients greater than 70 years of age. All patients were reviewed in February 2013 by an independent surgeon. Clinical, functional and radiographic assessments were performed. Mean follow-up was 25 months (range 17-36 months). Mean ROM was 45° (range 40-50°) in flexion and 44° (range 40-50°) in extension. Mean pronation-supination range was 160°. Mean grip strength was 18 kgf. Mean Quick DASH was 18.2/100 (range 6.82-29.55) and mean pain on VAS was 2.33 (range 0-4). X-rays did not reveal any implant loosening or ulnar translation of the carpus. Use of a wrist resurfacing implant led to rapid recovery of autonomy in elderly patients with comminuted distal radius fractures. It parallels the use of shoulder or elbow prostheses for complex joint fractures in the elderly.