Arthroscopic Wrist Arthrolysis After Wrist Fracture

Purpose: To evaluate the results of this surgical procedure in patients affected by wrist stiffness after wrist fracture. Criteria for patient inclusion in our preoperative and postoperative study were wrist stiffness with or without pain, decreased grip strength, and unsuccessful results 3 to 6 months after following a rehabilitation program. Methods: From 1988 to 2003, surgery was performed in 22 patients (16 men and 6 women) with a mean age of 37 years. Radiocarpal, midcarpal, and distal radioulnar joint portals were used in relation to the site of rigidity. Statistical evaluation was performed in all cases. Results: At a mean follow-up of 28 months (range, 9 to 144 months), no complications were documented. One case that was operated on bilaterally successively required an additional right wrist arthroscopic arthrolysis to reach the same level of improvement as that of the contralateral side. Pain was almost absent in all cases (P < .0001), and mean flexion/extension range of motion increased from 84° preoperatively to 99° postoperatively, mean pronation/supination increased from 144° to 159°, and mean grip strength increased from 22 to 28 kg (P < .0001). The mean modified Mayo wrist score improved from 28 to 79 postoperatively (P < .0001), and the mean postoperative score on the Disabilities of the Arm, Shoulder and Hand questionnaire was 21 points. Conclusions: Arthroscopic wrist arthrolysis is a suitable and promising surgical option for the treatment of wrist rigidity after trauma or surgery. In our series pain and wrist flexion-extension and grip strength significantly improved. The procedure is safe and required a minimal amount of invasive surgery while also permitting the surgeon to identify the precise cause of the intra-articular rigidity and pain. Level of Evidence: Level IV, therapeutic case series.

Key Words: Wrist arthroscopy, Wrist stiffness, Arthrolysis