Wrist and Hand Complications Philippe Kopylov Lund (Sweden)

Complications u Skin u Bone u Tendons u Ulna stump instability u Prosthesis u Osteosynthesis devices

Skin complication u Haematoma u Infection u Necrosis u Incision u Haemostasis

Bone complication u Fracture u Discrepancy bone weakness and patient need u Young demanding patient

Tendon complications u Tendon rupture u After synovectomy. Corticoids u Bony irregularity in Canal Carpi u Osteosynthesis devices u Ulna stump

Ulna stump instability u Frequent u In relation with patient activity, demand and need

Stability of the Wrist u Radiocarpal and midcarpal joints make a bloc u Ligaments avoid dislocation both ulnarly and anteriorly u In RA carpus tend to slide ulnarly and anteriorly

Stability of the Wrist u Ulnar head is immobile u Weight bearing part of the wrist u Radius and carpus attached by ulno-triquetral ligament u In RA by ligament distention or bone erosion –Radius/carpus dislocated anteriorly –Prominence of the ulnar head and Manu Supinata

Surgery of the DRU Joint u Painfree pronation/supination u Caput Ulnae resection u Translation of the carpus !!! u Ulna stump instability –Low vs high patient demand –Resection only when necessary –Minimal resection –Stabilization

Prosthesis complications u Luxation u Fracture of the implant (13% to 25%) u Bone erosion (grommets?) u Cement u Fracture close to the implant u Be prepare to revision Relation clinical and radiographical result

Osteosynthesis devices u Minimal hardware u Resorbable u Length of the implants

Conclusions

Wrist and Hand Complications