Background Wrist and carpal arthrodesis is a well-established surgical intervention in
orthopedic surgery, primarily aimed at alleviating chronic pain and restoring functional
stability. The procedure involves the fusion of two or more wrist bones, eliminating
joint mobility to reduce pain and improve hand function. It is generally considered a
last-resort treatment when conservative measures such as medication, physical therapy,
and orthotic support fail.
Candidates for arthrodesis typically include patients with severe degenerative changes,
rheumatoid arthritis, post-traumatic arthritis, or significant wrist trauma, where pain
and instability severely impair daily activities. The procedure aims to improve quality
of life by enabling essential functions without the limitations imposed by unstable or
arthritic joints.
Surgical success is measured primarily by pain relief and functional improvement.
Outcomes depend on careful patient selection, precise surgical technique, and structured
postoperative follow-up. Long-term studies and systematic evaluations are essential to
refine treatment protocols and identify predictive factors for successful outcomes while
mitigating complications such as infection, nonunion, and adjacent joint degeneration.
Objective This study evaluates the effectiveness and safety of various wrist and carpal
arthrodesis procedures, including radioscapholunate, scaphoid-trapezium-trapezoid (STT),
and four-corner arthrodesis, through systematic postoperative follow-up and patient
outcome assessment.
Methods Inclusion Criteria:
All patients undergoing wrist or carpal arthrodesis, regardless of the specific
technique.
Indications include advanced degenerative changes unresponsive to conservative
treatment.
Preoperative Evaluation:
Bilateral range-of-motion (ROM) assessment (flexion, extension, ulnar and radial
deviation, supination, pronation).
Imaging: X-ray (AP, lateral, oblique) and CT with 3D reconstruction.
Grip strength measurement with a dynamometer.
Pain assessment using the Numeric Rating Scale (NRS).
Patient-reported outcome measures (PROMs): PRWHE, QuickDASH, and EQ-5D-5L.
Postoperative Follow-up:
CT at 8 weeks to assess bone healing, with possible extension of cast duration and
reassessment at 12 weeks.
Referral to occupational therapy for rehabilitation.
Follow-up at 3 months and 1 year, repeating preoperative assessments and X-ray
evaluation for secondary osteoarthritis.
Data Collection & Analysis:
Pre- vs. postoperative comparisons of pain, function, and grip strength.
Statistical analyses: t-tests, chi-square, ANOVA, Cox regression, linear and
logistic regression.
Documentation of prior wrist surgeries and indications for arthrodesis.
Sample Size & Statistical Power: With an estimated annual inclusion of 1-5 patients and a
total of 10-20 participants, statistical power is limited. The study acknowledges the
risk of Type II errors due to small sample size.
Regulatory Approvals & Ethics:
The project was reviewed by the Regional Ethics Committee (REK) and deemed a quality
control study, not requiring REK approval.
Approval from the Data Protection Officer (PVO) in Vestre Viken is pending.
Patients will provide informed consent, ensuring voluntary participation and data
confidentiality.
Data Security & Management:
Anonymized data stored on a secure research server.
Key-coded data stored separately in Medinsight.
The study follows institutional guidelines for data protection and patient rights.
Expected Impact:
Timeline:
Regulatory approvals: Winter/Spring 2024.
Patient recruitment: Fall 2024.
Inclusion period: 5 years.
Follow-up completion: 1 year postoperatively for each patient.