total wrist fusion

The wrist joint is very important for the flexibility of the hand. The wrist joints, the wrist bones, and the wrist joints are involved in the wrist joint activities. Therefore, the wrist joints are divided into: wrists (skull, boat, lunate), carpal bones (boat, moon, skull), palm (wrist and metacarpal), and full wrist fusion. Wrist joint fusion refers to full wrist fusion. The wrist fusion only retains a little flexion and extension between the carpal bones, completely losing lateral activity, and is not as stable as the full wrist fusion. Wrist bone fusion, such as boat and lunate bone injury, has been replaced by many surgical procedures. The wrist fusion is mainly used for the first metacarpal and carpal bone fusion. The functional position of the wrist joint is 20° dorsiflexion, 5°10° in the neutral position or the ruler, and the grip strength of the hand is the largest. Wrist arthrodesis should be strictly in accordance with the indications, can be solved with other surgery, try not to do fusion, only the carpal bone destruction is serious, other surgery can not restore the function, only the fusion surgery. Treatment of diseases: wrist and tuberculosis distal radius fracture Indication Full wrist fusion is available for: 1. Total wrist joint TB bone destruction. 2. In the intra-articular comminuted fracture of the distal radius or the benign tumor to remove the joint, the joint can not be reconstructed. 3. Cerebral palpebrae and wrist joint flexion contracture deformity, with tendon transfer or other surgery can not stabilize the joint. 4. Suppurative infection caused by flexion and ankylosing of the carpometacarpal joint and could not restore joint function. 5. Distal humeral defect, not suitable for artificial humeral replacement and metatarsal metastasis. Contraindications Children between 10 and 12 years old. Surgical procedure Incision A midline straight incision on the dorsal aspect of the wrist, from the wrist 5 cm to the base of the third metacarpal. 2. Reveal Cut the skin and deep fascia, and retract the superficial branch of the radial nerve to expose the total tendon of the extension finger and the long tendon of the thumb. The transverse ligament of the dorsal aspect of the wrist was incised, and the length of the wrist and the short tendon were cut off in the proximal side of the 2nd and 3rd metacarpals. The extension of the total tendon is retracted to the ulnar side, and the longissimus tendon is stretched to the temporal side to reveal the wrist joint. 3. Remove the cartilage surface Longitudinal incision of the lower periosteum of the humerus and the dorsal joint capsule, peeling off to the sides, revealing the carpal bone and the proximal end of the 2nd and 3rd metacarpal, and using the osteotome to remove the humerus, the scapula, the moon, the skull cartilage surface and the 2, 3 metacarpal surface of the dorsal metacarpal (the carpal tuberculosis should first remove the lesion). Be careful not to damage the lower ankle joint. If there is a lesion, remove the distal end of the ulna to preserve the forearm rotation function. 4. Bone graft fusion The wrist was laid flat, and a 6 cm long and 1.5 cm wide bone piece was cut on the back of the lower end of the humerus with a chainsaw or a bone knife, and the slide was inserted into the wrist bone and the back of the 2nd and 3rd metacarpals. The sacral deformity caused by cerebral palsy is not strong enough, and it should be fixed with steel plate screws. 5. Suture incision Isotonic saline irrigation incision, relax the tourniquet, completely stop bleeding, fill the joint space with cancellous bone fragments, suture the dorsal ligament of the wrist and the tissue of the incision, covering the dressing. Keep the wrist back 15 ° ~ 20 °, the forearm rotates in the neutral position, the forearm plaster or tubular brake.

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