Forearm and wrist surgery

Typically in arthrogryposis, the wrist is flexed and ulnarly deviated. Soft tissue contractures may be present. With age, there is increasing bony fusion that makes surgical treatment more difficult.

Several approaches have been suggested to place the forearm in a better position for function:

• dorsal wedge osteotomy:
  • preferred approach in most patients
  • can correct wrist flexion and ulnar deviation
  • sited over mid-carpus and distal radius
  • tight volar forearm flexors may require lengthening
  • extensor carpi ulnaris may be transferred to improve extension on the radial side of the joint
• proximal row carpectomy:
  • beneficial if mild deformity
  • less extension achieved if initially start with excess flexion
  • prone to late recurrence
• distraction of soft tissue and bone:
  • recent development
  • uses multiplanar fixators
• arthrodesis of the wrist: tends to be used as the procedure of last resort