Introduction Carpal wedge osteotomy in an arthrogrypotic patient repositions the wrist in neutral alignment while preserving available wrist motion.
Step 1: Mark the Locations of the Incisions The location of the incisions allows excellent exposure of the wrist on both the volar and the dorsal surface.
Step 2: Release Tight Palmar Structures After making the incision, carefully assess tight flexor structures and perform release and/or lengthening as appropriate.
Step 3: Dorsal Exposure Make a dorsal transverse skin incision at the level of the carpus to allow identification and preservation of whichever thumb, finger, and wrist extensors are present.
Step 4: Carpal Osteotomy After careful exposure of the carpus, make the proximal and distal osteotomy cuts and then evaluate the resulting wrist position and stabilization.
Step 5: Transfer the Extensor Carpi Ulnaris Tendon Pass the extensor carpi ulnaris tendon to the radial wrist extensors and suture the tendon to the extensors.
Step 6: Postoperative Care Cast immobilization for six to eight weeks is followed by splinting for six months.
Results Our recently published study of patients with amyoplasia who underwent carpal wedge osteotomy showed that the corrected position was maintained and the individuals were satisfied with the results over the long term.
Pitfalls & Challenges
Carpal wedge osteotomy in an arthrogrypotic patient repositions the wrist in neutral alignment while preserving available wrist motion.
Under tourniquet control, the procedure begins with release of any tight palmar structures through an incision in the distal part of the forearm on the palmar side. Tight fascia is released, followed by assessment of wrist, finger, and thumb flexors. If any of these are tight they can be lengthened at the intramuscular level or they can be z-lengthened.
A dorsal transverse incision is then made overlying the proximal part of the carpus with isolation and …
Enter your JBJS login information below.