ABSTRACT
SURGICAL OPTIONS Manage each involved joint. Patient considerations: Age, hand dominance, occupation, functional demands, and involvement of contralateral wrist n Isolated pisotriquetral joint
• Responds well to pisiform excision (if conservative management was unsuccessful) n Isolated RC joint
• Radioscapholunate (RSL) fusion (partial arthrodesis) n Isolated midcarpal joint
• Midcarpal fusion (partial arthrodesis)
n Isolated DRU joint • Ulnar head arthroplasty (hemiarthroplasty or constrained): Preserves forearm rotation
n Total wrist involvement • Total wrist arthrodesis/fusion (TWF) in 20 degrees of extension (prebent dorsal plates) • Total wrist arthroplasty • Both options can be combined with Darrach resection (distal ulna) or ulnar head
arthroplasty.
