RESUMO
The history and evolution of both soft tissue and implant arthroplasty about the wrist are discussed, including carpometacarpal, radiocarpal, and distal radioulnar joints. Technical considerations for arthroplasty are reviewed, including factors affecting implant osseointegration, implant articulation/constraint, and management of complications.
Assuntos
Artroplastia de Substituição , Artroplastia , Prótese Articular , Articulação do Punho/cirurgia , Artrodese , Artroplastia/tendências , Artroplastia de Substituição/tendências , Cimentos Ósseos , Ossos do Carpo/cirurgia , Articulações Carpometacarpais/fisiopatologia , Articulações Carpometacarpais/cirurgia , História do Século XX , História do Século XXI , Humanos , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Osseointegração , Osteoartrite/fisiopatologia , Osteoartrite/cirurgia , Seleção de Pacientes , Desenho de Prótese , Falha de Prótese , Infecções Relacionadas à Prótese/prevenção & controle , Terapia de Salvação , Tendões/cirurgia , Trapézio/cirurgia , Articulação do Punho/fisiopatologiaRESUMO
Despite reports of high nonunion rates for isolated talonavicular fusion, this procedure may be indicated for some patients, including those for whom increased stability of the talonavicular joint in triple arthrodesis is needed. In the biomechanical cadaveric study reported here, we evaluated fixation methods used to provide optimal stability of talonavicular arthrodesis. A physiologic 3-point loading model was used to measure dorsal displacement of the navicular on the talus with 1 or 2 cannulated 4.5-mm screws across the talonavicular joint both with and without one 7.3-mm cannulated screw across the subtalar joint. Statistically significant differences in displacement under cyclic loading to one-half body weight were found. Use of 2 talonavicular screws and no subtalar screw or 1 talonavicular screw plus 1 subtalar screw decreased the motion, as compared with use of 1 talonavicular screw and no subtalar screw.
