The main causes of the clinical-radiographicvariants of wrist joint osteoarthritis

Sergey Strafun, Sergey Timoshenko

Abstract


Wrist joint osteoarthritis (WJO) – is a widespread damage causing pain in the wrist in 13 % of cases.

The goal: to clarify views on the etiology, pathogenesis and structural-functional state of wrist in case of osteoarthritis, form the principles of generalization of this damage.

Methods: 155 patients with WJO of different etiology underwent surgical treatment, had the basic skialogic parameters quantitatively evaluated, such as indicators of wrist instability, zonal distribution of the degree of degenerative changes in its different areas, depending on its etiology and pathomechanism and functional state of the upper limb on a scale of DASH.

The results: the greatest clinical significance had WJO due to scaphoid fractures (39 %), and Kienbock’s disease (20 %), less — due perilunate damages (12 %), idiopathic osteoarthritis (11 %). Among the main pathological mechanisms of WJO — the collapse of the wrist with a rotary installation of scaphoid (the consequences of its fracture, perilunarny injury, Kienbock’s disease); rarely ulna-wrist or ilna- radius conflicts, consequences of fractures of distal radius metaepiphysis of the idiopathic form; carpometacarpal arthritis, microfractures with reparative reaction of the back parts of these joints. WJO is characterized by the following symptoms: late referral of patients (at stage II–III), a long period of compensation of arthritic changes till its failure due to excessive stress or minor injury, the dissonance between radiographic and clinical pictures, loss of function predominantly from contracture and synovitis than the from stage of the disease and timing. Classification that was composed on the background of clinical-radiological signs and syndromic principle allows not only to structure WJO according to location and mechanisms of formation, but gives an opportunity to determine the key requirements for a choice of treatment tactics.

Keywords


wrist joints; osteoarthritis; wrist collapse; ulna-wrist conflict; classification

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DOI: https://doi.org/10.15674/0030-59872016195-104

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