Carpal Wedge Osteotomy in the Arthrogrypotic Patient.

Abstract

Carpal wedge osteotomy in an arthrogrypotic patient repositions the wrist in neutral alignment while preserving available wrist motion. The location of the incisions allows excellent exposure of the wrist on both the volar and the dorsal surface. After making the incision, carefully assess tight flexor structures and perform release and/or lengthening as appropriate. Make a dorsal transverse skin incision at the level of the carpus to allow identification and preservation of whichever thumb, finger, and wrist extensors are present. After careful exposure of the carpus, make the proximal and distal osteotomy cuts and then evaluate the resulting wrist position and stabilization. Pass the extensor carpi ulnaris tendon to the radial wrist extensors and suture the tendon to the extensors. Cast immobilization for six to eight weeks is followed by splinting for six months. Our recently published study of patients with amyoplasia who underwent carpal wedge osteotomy showed that the corrected position was maintained and the individuals were satisfied with the results over the long term.IndicationsContraindicationsPitfalls & Challenges.