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THU0231 Surgical Treatment of the Dorsal Rheumatoid Wrist : A Long Term Assessment of the Subjective Results
  1. A. Petit1,
  2. J. Laulan1
  1. 1Hand Surgery Unit, CHRU Tours, Tours, France

Abstract

Background Wrist problems occur frequently in rheumatoid arthritis, affecting 65 to 95% of cases. The goal of the surgical treatment is to ensure a correct function without return of normal anatomy.

Objectives The purpose of this work is to evaluate the long-term subjective satisfaction of patients undergoing dorsal wrist arthritis. Ninety-five wrists operated between 1995 and 2008 were evaluated with an average of 9 years.

Methods From 1995 to 2008, 144 dorsal rheumatoid wrists were operated in 128 patients. Among these 128 patients, 68 patients corresponding to 95 wrists operated responded to a questionnaire by telephone during the first half of 2009. Different parameters were studied: objective clinical parameters (visual pain-rating scale VAS), subjective clinical parameters (the impact of wrist surgery on quality of life, subjective feeling of stiffness in the wrist, the strength of the wrist, the subjective assessment of pain and overall satisfaction of the patient). Finally, the functional score of the upper limb QuickDASH was made.

Results At the medical inspection after the surgery, 84 wrists (88%) were pain improved since the surgery, while 11 wrists (12%) were unimproved or worse. Eighty-eight wrists (92%) were satisfied or very satisfied, while 7 wrists (8%) were not satisfied with the operation. Eighty-five wrists would be operated again while 10 wrists would not do or are uncertain about the idea of re-operation. VAS average was estimated at 3. The average DASH at the medical inspection after the surgery was 39 (from 0 to 90). The wrists treated with total arthrodesis had a feeling of stiffness significantly higher than the wrists having received another stabilization procedure. Wrists with healthy tendons in the per-operative period had a feeling of stiffness higher than the group of injured or broken tendons. Patients with healthy tendons are more often found among those who would not re-operate or would be uncertain about the idea of re-operation.

Conclusions Surgery of dorsal rheumatoid wrist presents good results, which seem to have a long-term efficacy. This is a winner treatment, regardless of the type of operation. Pain sedation is almost always obtained. Preventive surgery must be balanced with the fact that it brings less subjective patient satisfaction. Palliative surgery is more stiffness-giving but provides an excellent subjective patient satisfaction.

Disclosure of Interest None Declared

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