PRIMARY AND REVISION WRIST ARTHRODESIS AND THEIR CORRELATION WITH DARRACH’S PROCEDURE

Abstract

Introduction: Darrach’s procedure is indicated for conditions were the distal radio-ulnar joint movement is painful or restricted. The procedure may be indicated at the time of wrist arthrodesis. Darrach’s procedure is not without complications and revision surgery may be indicated.

Aims: To determine the success rate following wrist arthrodesis and whether Darrach’s procedure correlates to revision surgery.

Methods: A retrospective case note review was performed of a consecutive series of patients who underwent wrist arthrodesis between 1991 and 2002 at our institution; performed by a single surgeon.

Results: 73 patients underwent wrist arthrodesis. 39 were female and 34 male. The indications for wrist arthrodesis were rheumatoid disease, osteoarthritis, carpal instability and failed wrist arthroplasty. Successful arthrodesis was achieved in 82% (60/73) of patients, where revision arthrodesis was defined as the end point. 25% (18/73) patients underwent Darrach’s procedure at the time of their primary arthrodesis. 25% (15/60) of the patients whose primary arthrodesis was successful underwent concomitant Darrach’s procedure. 23% (3/13) of patients who underwent revision arthrodesis had undergone concomitant Darrach’s procedure during their primary arthrodesis. 77% (10/13) patients who underwent revision arthrodesis did not undergo Darrach’s procedure at the time of their primary arthrodesis. Of these 10 patients, 3 (30%) of them underwent concomitant Darrach’s procedure during revision arthrodesis.

Conclusion: Wrist arthrodesis in our institution is comparable with that of published literature. The incidence of Darrach’s procedure at the time of primary wrist arthrodesis is 25%. There is a small increase to 30% in the number of patients who require Darrach’s procedure at the time of revision arthrodesis, which is not statistically significant.