The Open Orthopaedics Journal




ISSN: 1874-3250 ― Volume 13, 2019
REVIEW ARTICLE

Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature



Ingo Schmidt1, *
1 Medical Centre Wutha-Farnroda, Department of Orthopaedics, Hospital Bad Salzungen GmbH, Germany, Teaching Hospital of the Friedrich-Schiller-University Jena, Germany, Ringstr. 20, 99848 Wutha-Farnroda, Germany

Abstract

Background:

Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.

Aims:

The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.

Methods:

In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist.

Results and Conclusion:

Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.

Keywords: Wrist, Osteoarthritis, Four-corner fusion, Proximal row carpectomy, Total wrist arthroplasty, Total wrist fusion, Denervation.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 217
Last Page: 231
Publisher Id: TOORTHJ-13-217
DOI: 10.2174/1874325001913010217

Article History:

Received Date: 10/03/2019
Revision Received Date: 24/06/2019
Acceptance Date: 25/06/2019
Electronic publication date: 15/11/2019
Collection year: 2019

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 309
Abstract HTML Views: 147
PDF Downloads: 82
ePub Downloads: 80
Total Views/Downloads: 618

Unique Statistics:

Full-Text HTML Views: 193
Abstract HTML Views: 104
PDF Downloads: 62
ePub Downloads: 64
Total Views/Downloads: 423
Geographical View

© 2019 Ingo Schmidt.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Medical Centre Wutha-Farnroda Department of Orthopaedics, Hospital Bad Salzungen GmbH, Germany, Teaching Hospital of the Friedrich-Schiller-University Jena, Germany, Ringstr. 20, 99848 Wutha-Farnroda, Germany; E-mail: schmidtingo62@googlemail.com





1. WHICH SALVAGE PROCEDURES EXIST AND WHICH WRIST MOTION IS NEEDED?

Salvage procedures for the treatment of painful post-traumatic or non-traumatic wrist Osteoarthritis (OA) contain generally five main groups: (1) Partial motion-preserving Partial Wrist Fusion (PWF) such as the four-corner fusion (4CF); (2) Partial motion-preserving resection arthroplasty such as Proximal Row Carpectomy (PRC); (3) Complete motion-preserving Total (or partial) Wrist Arthroplasty (TWA); (4) Complete motion-restricting Total Wrist Fusion (TWF); and (5) Partial or complete motion-preserving wrist denervation as an additional procedure to PWF or PRC, or as a sole procedure when the other procedures are not possible in special situations. It has been noted by Sterling Bunnel (1882-1957): “A painless stable wrist is the key to hand function“ [1Gupta A. Total wrist arthroplasty. Am J Orthop 2008; 37(8)(Suppl. 1): 12-6.
[PMID: 18836607]
]. That means that all motion-preserving salvage procedures at the wrist must ensure sufficient stability in order to provide functional tasks in activities of daily living for the patients. Fortunately, the overall wrist motion is not needed in every instance especially for the elderly or so-called low-demand patients. It is still widely known from the literature that for the wrist 5° to 40° of flexion, 30° to 40° of extension, and 10°/15° of radial/ulnar deviation or 40° of overall radial-ulnar motion arc are required only to perform the most essential activities of daily living, and 21 out of 24 of them are performed with the wrist mostly in extension [2Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985; 10(1): 39-46.
[http://dx.doi.org/10.1016/S0363-5023(85)80246-X] [PMID: 3968403]
-4Brumfield RH, Champoux JA. A biomechanical study of normal functional wrist motion. Clin Orthop Relat Res 1984; (187): 23-5.
[http://dx.doi.org/10.1097/00003086-198407000-00004] [PMID: 6744724]
], and noted that optimal wrist function in healthy subjects requires only a range of motion (ROM) from 10° of flexion to 35°of extension. Volz et al. [5Volz RG, Lieb M, Benjamin J. Biomechanics of the wrist. Clin Orthop Relat Res 1980; (149): 112-7.
[PMID: 7408289]
] found that in normal volunteers the poorest performance was associated with only 15° of wrist extension. Recently, Biehl et al. [6Biehl C, Braun T, Thormann U, Oda A, Szalay G, Rehart S. Radiocarpal fusion and midcarpal resection interposition arthroplasty: long-term results in severely destroyed rheumatoid wrists. BMC Musculoskelet Disord 2018; 19(1): 286.
[http://dx.doi.org/10.1186/s12891-018-2172-x] [PMID: 30103715]
] reported that elderly patients (34 wrists in 28 patients, average age 60.6 years) with severely destroyed rheumatoid wrists sustained radiocarpal fusions and rated their long-term outcomes with “satisfactory” in the presence of mean extension/flexion of 22.5° /15.97° whilst “unsatisfactory” with a mean extension /flexion of 11°/1.6°. Moreover, patients who sustained partial motion-preserving PRC rated their outcomes in Disability of Arm, Shoulder and Hand (DASH) questionnaire highly significantly better than patients sustained TWF (p < 0.001) [7De Smet L, Degreef I, Truyen J, Robijns F. Outcome of two salvage procedures for posttraumatic osteoarthritis of the wrist: Arthrodesis or proximal row carpectomy. Acta Chir Belg 2005; 105(6): 626-30.
[http://dx.doi.org/10.1080/00015458.2005.11679790] [PMID: 16438073]
], and these results are comparable to those after complete motion-preserving TWA utilizing the Patient-Rated Wist Evaluation (PRWE) [8Nydick JA, Watt JF, Garcia MJ, Williams BD, Hess AV. Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 2013; 38(5): 899-903.
[http://dx.doi.org/10.1016/j.jhsa.2013.02.013] [PMID: 23561729]
]. However, all salvage procedures are not free of any difficulties and complications, thus, a detailed understanding of the risk factors is essential for surgeons so that patients may be counselled accordingly and that alternative treatment options may be considered [9Gaspar MP, Lou J, Kane PM, Jacoby SM, Osterman AL, Culp RW. Complications following partial and total wrist Arthroplasty: A Single-Center retrospective review. J Hand Surg Am 2016; 41(1): 47-53.e4.
[http://dx.doi.org/10.1016/j.jhsa.2015.10.021] [PMID: 26710734]
].

2. WHERE DOES WRIST MOTION TAKE PLACE, AND WHAT CAN WE EXPECT WITH MOTION-PRESERVING PROCEDURES (EXCLUDING WRIST DENERVATION)?

In the literature, it is still controversial about the relative contributions in radiocarpal and midcarpal joint during wrist motion (Fig. 1). The relative portion for flexion is reported to be 40 to 63% radiokarpal and 36 to 60% midcarpal, and for extension 50 to 66,5% radiokarpal and 33,5 to 50% midcarpal [5Volz RG, Lieb M, Benjamin J. Biomechanics of the wrist. Clin Orthop Relat Res 1980; (149): 112-7.
[PMID: 7408289]
, 10Ruby LK, Cooney WP III, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am 1988; 13(1): 1-10.
[http://dx.doi.org/10.1016/0363-5023(88)90189-X] [PMID: 3351212]
-12Gellman H, Kauffman D, Lenihan M, Botte MJ, Sarmiento A. An in vitro analysis of wrist motion: The effect of limited intercarpal arthrodesis and the contributions of the radiocarpal and midcarpal joints. J Hand Surg Am 1988; 13(3): 378-83.
[http://dx.doi.org/10.1016/S0363-5023(88)80013-3] [PMID: 3379274]
]. For radial-ulnar deviation, the relative portion of midcarpal motion accounts approximately 75% vs. 25% radiocarpal [10Ruby LK, Cooney WP III, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am 1988; 13(1): 1-10.
[http://dx.doi.org/10.1016/0363-5023(88)90189-X] [PMID: 3351212]
, 13Kaufmann R, Pfaeffle J, Blankenhorn B, Stabile K, Robertson D, Goitz R. Kinematics of the midcarpal and radiocarpal joints in radioulnar deviation: an in vitro study. J Hand Surg Am 2005; 30(5): 937-42.
[http://dx.doi.org/10.1016/j.jhsa.2005.05.016] [PMID: 16182048]
], and the centre of axis for this motion is placed up to 6,8 mm distal to the axis for extension-flexion at the proximal capitate pole [14Andrews JG, Youm Y. A biomechanical investigation of wrist kinematics. J Biomech 1979; 12(1): 83-93.
[http://dx.doi.org/10.1016/0021-9290(79)90012-5] [PMID: 762184]
, 15Leonard L, Sirkett D, Mullineux G, Giddins GE, Miles AW. Development of an in-vivo method of wrist joint motion analysis. Clin Biomech (Bristol, Avon) 2005; 20(2): 166-71.
[http://dx.doi.org/10.1016/j.clinbiomech.2004.09.005] [PMID: 15621321]
]. When the wrist is held in a neutral position, the relative portion of loading is 50% in radioscaphoid fossa, 35% in radiolunate fossa, and 15% in ulnocarpal fossa [16Hara T, Horii E, An KN, Cooney WP, Linscheid RL, Chao EY. Force distribution across wrist joint: Application of pressure-sensitive conductive rubber. J Hand Surg Am 1992; 17(2): 339-47.
[http://dx.doi.org/10.1016/0363-5023(92)90417-N] [PMID: 1564285]
]. Wrist motion from extension-radial deviation to flexion-ulnar deviation (i.e. „dart-throwing“ motion) takes place in a midcarpal oblique axis which is angled 28° to 57° relative to the extension-flexion axis, whereas from extension-ulnar deviation to flexion-radial deviation (i.e. “reversed dart-throwing” motion) in radiocarpal joint [17Moritomo H, Apergis EP, Garcia-Elias M, Werner FW, Wolfe SW. International Federation of Societies for Surgery of the Hand 2013 Committee’s report on wrist dart-throwing motion. J Hand Surg Am 2014; 39(7): 1433-9.
[http://dx.doi.org/10.1016/j.jhsa.2014.02.035] [PMID: 24888529]
, 18Vardakastani V, Bell H, Mee S, Brigstocke G, Kedgley AE. Clinical measurement of the dart throwing motion of the wrist: Variability, accuracy and correction. J Hand Surg Eur Vol 2018; 43(7): 723-31.
[http://dx.doi.org/10.1177/1753193418773329] [PMID: 29754522]
], however, Kane et al. [19Kane PM, Vopat BG, Mansuripur PK, et al. Relative contributions of the midcarpal and radiocarpal joints to dart-thrower’s motion at the wrist. J Hand Surg Am 2018; 43(3): 234-40.
[http://dx.doi.org/10.1016/j.jhsa.2017.10.017] [PMID: 29146510]
] found that “dart-throwing” motion can also take place in radiocarpal joint. For circumduction, the largest total ROM in a human fresh-frozen cadaveric model is approximately 178° ± 10.5° and is oriented in the oblique direction of radial extension and ulnar flexion [20Crisco JJ, Heard WM, Rich RR, Paller DJ, Wolfe SW. The mechanical axes of the wrist are oriented obliquely to the anatomical axes. J Bone Joint Surg Am 2011; 93(2): 169-77.
[http://dx.doi.org/10.2106/JBJS.I.01222] [PMID: 21248214]
].

Fig. (1)
Extension and flexion with terminal ROM in a healthy wrist of a 43-year-old male: In extension, the relative portion in midcarpal joint is approximately two-third whereas in flexion radio- and midcarpal motion is approximately equally divided (red lines). During extension, the anatomically determined dorsal-volar slope of radial articular surface allows a slight translocation of lunate to volar (arrow) accompanied by its more tilting in radiolunate joint to dorsal than during flexion to volar (yellow points and lines), and followed by more tilting of capitate in lunate-capitate joint to dorsal compared to volar during flexion (red lines).


Fig. (2)
42-year-old male with SNAC II in his right wrist, surgically treated by 4CF, pre- and postoperative extension and flexion with terminal ROM: (A) Preoperative. (B) Six months after 4CF, flexion with 62% is significantly more worsened than extension with 47% compared to preoperative.


These biomechanical fundamentals declare that in every instance a PWF (i.e. radiocarpal or midcarpal) was done, extension and flexion are decreased approximately up to 50% compared to preoperative, despite preservation of carpal height (Figs. 2 A-B) [21Meyerdierks EM, Mosher JF, Werner FW. Limited wrist arthrodesis: a laboratory study. J Hand Surg Am 1987; 12(4): 526-9.
[http://dx.doi.org/10.1016/S0363-5023(87)80201-0] [PMID: 3611648]
]. Moreover, these biomechanics declare as well that after PWF the wrist is compromised due to the increased compressive forces in the surrounding intercarpal joints which is to be considered generally as a predisposition for secondary OA [22Gíslason MK, Stansfield B, Bransby-Zachary M, Hems T, Nash DH. Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study. J Hand Surg Eur Vol 2012; 37(9): 871-8.
[http://dx.doi.org/10.1177/1753193412441761] [PMID: 22457257]
]. Furthermore, due to the coupled motion between extension-flexion and radial-ulnar deviation [23Li ZM, Kuxhaus L, Fisk JA, Christophel TH. Coupling between wrist flexion-extension and radial-ulnar deviation. Clin Biomech (Bristol, Avon) 2005; 20(2): 177-83.
[http://dx.doi.org/10.1016/j.clinbiomech.2004.10.002] [PMID: 15621323]
], impaired wrist extension-flexion inevitably can lead to impairment of “dart-throwing” motion [24Garg R, Kraszewski AP, Stoecklein HH, et al. Wrist kinematic coupling and performance during functional tasks: effects of constrained motion. J Hand Surg Am 2014; 39(4): 634-642.e1.
[http://dx.doi.org/10.1016/j.jhsa.2013.12.031] [PMID: 24582842]
], but it is not always observed after radiocarpal fusion, 4CF, and PRC [25Rust PA, Manojlovich LM, Wallace R. A comparison of dart thrower’s range of motion following radioscapholunate fusion, four-corner fusion and proximal row carpectomy. J Hand Surg Eur Vol 2018; 43(7): 718-22.
[http://dx.doi.org/10.1177/1753193418783330] [PMID: 29950134]
].

PRC (i.e. without replacement of midcarpal joint) is associated with loss of carpal height (i.e. translocation of the rotation centre to proximal) by creating “one new” radiocapitate joint in the absence of a distal congruent partner for the anatomically determined ellipsoid surface articulation like in a normal radiocarpal joint. Therefore, it also inevitably leads to a methodology-related decrease of wrist extension-flexion, but approximately 15% lesser than after 4CF (Figs. 3 A-B) [26Singh HP, Brinkhorst ME, Dias JJ, Moojen T, Hovius S, Bhowal B. Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion. J Hand Surg Am 2014; 39(12): 2424-33.
[http://dx.doi.org/10.1016/j.jhsa.2014.09.005] [PMID: 25443170]
]. In a human fresh-frozen cadaveric model with 3D computed tomography evaluation, it was found that despite wrist motion significantly decreases 28% for flexion and 30% for extension, the much more smaller contact area of the proximal capitate pole as compared to the articular surface of the lunate allows a greater action radius of the capitate in the lunate fossa accompanied by its translocation in all directions during motion, and resulting in an increase for flexion/extension to 140%/146% compared with in midcarpal joint of an intact wrist, and to 136%/135% compared with in radiocarpal joint of an intact wrist [27Blankenhorn BD, Pfaeffle HJ, Tang P, Robertson D, Imbriglia J, Goitz RJ. Carpal kinematics after proximal row carpectomy. J Hand Surg Am 2007; 32(1): 37-46.
[http://dx.doi.org/10.1016/j.jhsa.2006.10.014] [PMID: 17218174]
]. However, this unphysiological movement, combined with 3.8 times increase of contact pressure to a normal radiocarpal joint [28Tang P, Gauvin J, Muriuki M, Pfaeffle JH, Imbriglia JE, Goitz RJ. Comparison of the “contact biomechanics” of the intact and proximal row carpectomy wrist. J Hand Surg Am 2009; 34(4): 660-70.
[http://dx.doi.org/10.1016/j.jhsa.2008.12.004] [PMID: 19345868]
], makes this “new joint” susceptible to secondary OA as well.

Fig. (3)
41-year-old male with SNAC II in his left wrist, surgically treated by PRC, pre- and postoperative extension and flexion with terminal ROM: (A) Preoperative. (B) Six months after PRC, flexion with 64% is significantly more worsened than extension with 32% compared to preoperative. Compared to the motion after 4CF in Fig. (2 A-B), the loss for flexion is approximately equally high whilst the loss for the extension is 15% significantly lower than after 4CF.


TWA utilizing the modern biaxial-anatomic 3rd generation types (Universal2/Freedom, Re-MotionTM, MaestroTM), introduced in the beginning of 2000, is also associated with removal of midcarpal joint, but it preserves both carpal height and the rotation centre, and maintains ellipsoid surface articulation (metal-on-polyethylene articulation, carpal peg into the capitate) like an intact radiocarpal joint. Thus, overall wrist motion (ROM) is slightly or significantly increased or at least unchanged postoperatively (Figs. 4 A-D [29Schmidt I. Combined replacements using the Maestro total wrist and uHead ulnar head implants. J Hand Surg Eur Vol 2015; 40(7): 754-5.
[http://dx.doi.org/10.1177/1753193414535721] [PMID: 24835474]
, 30Schmidt I. Combined replacements of the wrist, ulnar head, andthumbcarpometacarpal joint. Case report, technical noteand recent evidence to the ArpeTM prosthesis. Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000130]
]), however, TWA is unable to completely restore circumduction (20% of a normal wrist is maintained with the Universal 2) as well as stress distribution like in a normal wrist [31Werner FW. Wrist Biomechanics: In the normal wrist, following injury and after surgical treatment. Curr Rheumatol Rev 2012; 8(4): 285-7.
[http://dx.doi.org/10.2174/157339712805077159]
-35Singh HP, Bhattacharjee D, Dias JJ, Trail I. Dynamic assessment of the wrist after total wrist arthroplasty. J Hand Surg Eur Vol 2017; 42(6): 573-9.
[http://dx.doi.org/10.1177/1753193417690472] [PMID: 28196435]
]. A revival of the 2nd generation types (ball joint with metal-on-metal articulation, carpal peg into the 3rd metacarpal crossing the 3rd carpometacarpal joint) is seen with the Motec® [36Reigstad O, Røkkum M. Wrist arthroplasty using prosthesis as an alternative to arthrodesis: design, outcomes and future. J Hand Surg Eur Vol 2018; 43(7): 689-99.
[http://dx.doi.org/10.1177/1753193418784707] [PMID: 29985078]
].

3. WHAT IS EVIDENT WHEN WRIST MOTION IS IMPAIRED?

Adams et al. [37Adams BD, Grosland NM, Murphy DM, McCullough M. Impact of impaired wrist motion on hand and upper-extremity performance(1). J Hand Surg Am 2003; 28(6): 898-903.
[http://dx.doi.org/10.1016/S0363-5023(03)00424-6] [PMID: 14642503]
] demonstrated that, in young healthy subjects, limited wrist motion inevitably led to a statistically significant worsening of their ratings in activities of daily living (DASH, PRWE), and limited or completely restricted wrist motion with or without pain is subsequently accompanied by impaired power and performance both in elbow and shoulder [6Biehl C, Braun T, Thormann U, Oda A, Szalay G, Rehart S. Radiocarpal fusion and midcarpal resection interposition arthroplasty: long-term results in severely destroyed rheumatoid wrists. BMC Musculoskelet Disord 2018; 19(1): 286.
[http://dx.doi.org/10.1186/s12891-018-2172-x] [PMID: 30103715]
, 38Cantero-Téllez R, Orza SG, Bishop MD, Berjano P, Villafañe JH. Duration of wrist immobilization is associated with shoulder pain in patients with after wrist immobilization: An observational study. J Exerc Rehabil 2018; 14(4): 694-8.
[http://dx.doi.org/10.12965/jer.36292.146] [PMID: 30276195]
]. In patients sustained TWF, the lowest scores found were for perineal hygiene, using a screwdriver, and trouble using the hand in tight spaces such as changing spark plugs on the family car, followed by writing, drinking from a glass, turning a doorknob, combing hair, and using a hammer (i.e. “dart-throwing” motion) [39Weiss AC, Wiedeman G Jr, Quenzer D, Hanington KR, Hastings H II, Strickland JW. Upper extremity function after wrist arthrodesis. J Hand Surg Am 1995; 20(5): 813-7.
[http://dx.doi.org/10.1016/S0363-5023(05)80437-X] [PMID: 8522750]
]. However, limited wrist motion can be compensated over a not clearly known time by increased activities of trunk and shoulder muscles such as the upper trapezius and deltoideus [37Adams BD, Grosland NM, Murphy DM, McCullough M. Impact of impaired wrist motion on hand and upper-extremity performance(1). J Hand Surg Am 2003; 28(6): 898-903.
[http://dx.doi.org/10.1016/S0363-5023(03)00424-6] [PMID: 14642503]
, 40Jung HY, Chang M, Kim KM, Yoo W, Jeon BJ, Hwang GC. Effect of wrist joint restriction on forearm and shoulder movement during upper extremity functional activities. J Phys Ther Sci 2013; 25(11): 1411-4.
[http://dx.doi.org/10.1589/jpts.25.1411] [PMID: 24396200]
, 41Gomes AD, Macedo Ricci FPF, Zampar AC, Pereira Santiago PR, de Cássia Registro Fonseca M. Influence of static wrist orthosis on muscle activity and shoulder and elbow range of motion during a functional task: a biomechanical study. Fisioter Pesqui 2018; 25(1): 56-64.
[http://dx.doi.org/10.1590/1809-2950/17016425012018]
]. But the question is: are elderly patients with their age-related overall muscle degenerations able for this compensation mechanism, and if yes, how long, and what about the number of subsequently following functional disorders in elbow and shoulder in patients with longstanding impaired wrist motion?

Fig. (4)
Two-year follow-up of a 55-year-old patient with right primary wrist OA and sustained a TWA with the Maestro implant, this case was previously published by the author at a five- and six-year follow up [29Schmidt I. Combined replacements using the Maestro total wrist and uHead ulnar head implants. J Hand Surg Eur Vol 2015; 40(7): 754-5.
[http://dx.doi.org/10.1177/1753193414535721] [PMID: 24835474]
, 30Schmidt I. Combined replacements of the wrist, ulnar head, andthumbcarpometacarpal joint. Case report, technical noteand recent evidence to the ArpeTM prosthesis. Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000130]
, 115Schmidt I. RE-MOTIONTM total wrist arthroplasty for treatmentof advanced stage of scaphoid non-union advancedcollapse. Does excision of the entire scaphoid bone preventimpingement at terminal range of radial deviation? Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000127]
, 118Schmidt I. A critical appraisal to the decision by the company zimmer biomet to withdraw the maestroTM wrist reconstructive system from the marketplace. Trauma Emerg Care 2018; 3(1)
[http://dx.doi.org/10.15761/TEC.1000162]
], same patient as in Figs. (6 A-E and 7 A-E): (A)
Radial deviation has significantly improved with 11° (+58%). Note that there is no radial impingement (arrow). (B) Ulnar deviation has significantly improved with 9° (+30%). (C) Extension has slightly improved with 3° (+9%). (D) Flexion has slightly improved with 2° (+9%).


4. DOES THE OBJECTIVE FUNCTIONAL OUTCOME MEASURED BY THE SURGEON ALWAYS CORRELATE WITH THE SELF-REPORTED OUTCOME BY THE PATIENT?

One question is not clearly answered currently: What is better in the assessment of postoperative outcomes at the wrist: measurement of movement by the surgeon or self-reported outcome by the patient? Despite some limitations, since introducing the DASH questionnaire by Hudak et al. [42Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29(6): 602-8.
[http://dx.doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L] [PMID: 8773720]
] with the mean value of 10.1 (SD 14.88) in a normal population [43Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002; 84(2): 208-15.
[http://dx.doi.org/10.2106/00004623-200202000-00007] [PMID: 11861726]
], this questionnaire has proven to be one of the most popular and reliable self-reported outcome evaluations for the wrist and hand all over the world, and McCullough et al. [33McCullough M BA, Adams BD, Grosland NM. Postoperative analysis of patients who received the Universal 2 total wrist implant system. J Appl Biomech 2012; 28(4): 466-72.
[http://dx.doi.org/10.1123/jab.28.4.466] [PMID: 22085923]
] found no significant differences in comparison to PRWE in assessment of self-reported outcomes after TWA. However, in the literature, it is still controversial whether postoperative objective measurements of wrist motion correlates with the self-reported DASH by the patients [44Jester A, Harth A, Wind G, Germann G, Sauerbier M. [Does the disability of shoulder, arm and hand questionnaire (DASH) replace grip strength and range of motion in outcome-evaluation?]. Handchir Mikrochir Plast Chir 2005; 37(2): 126-30.
[http://dx.doi.org/10.1055/s-2004-821279] [PMID: 15877274]
, 45De Smet L. Does restricted wrist motion influence the disability of the upper limb? Acta Orthop Belg 2007; 73(4): 446-50.
[PMID: 17939473]
], and care must be taken when pre-existent or concomitant disorders at the shoulder, elbow, forearm, and lower extremity are present [6Biehl C, Braun T, Thormann U, Oda A, Szalay G, Rehart S. Radiocarpal fusion and midcarpal resection interposition arthroplasty: long-term results in severely destroyed rheumatoid wrists. BMC Musculoskelet Disord 2018; 19(1): 286.
[http://dx.doi.org/10.1186/s12891-018-2172-x] [PMID: 30103715]
, 46Dowrick AS, Gabbe BJ, Williamson OD, Cameron PA. Does the disabilities of the arm, shoulder and hand (DASH) scoring system only measure disability due to injuries to the upper limb? J Bone Joint Surg Br 2006; 88(4): 524-7.
[http://dx.doi.org/10.1302/0301-620X.88B4.17223] [PMID: 16567790]
-48Wagner ER, Elhassan BT, Kakar S. Long-term functional outcomes after bilateral total wrist arthrodesis. J Hand Surg Am 2015; 40(2): 224-228.e1.
[http://dx.doi.org/10.1016/j.jhsa.2014.10.032] [PMID: 25510154]
]. Yang et al. [49Yang Z, Lim PPH, Teo SH, Chen H, Qiu H, Pua YH. Association of wrist and forearm range of motion measures with self-reported functional scores amongst patients with distal radius fractures: a longitudinal study. BMC Musculoskelet Disord 2018; 19(1): 142.
[http://dx.doi.org/10.1186/s12891-018-2065-z] [PMID: 29747624]
] found in patients sustained distal radius fractures that wrist extension, active thumb opposition, and the ability to make a full composite grip were among the strongest ROM measures associated with the QuickDASH whilst wrist radial deviation and forearm pronation were not statistically significantly associated with this score.

Furthermore, when evaluating the DASH or QuickDASH among patients between different studies, particularly in the elderly, newer studies revealed that age- and gender-related features should be borne in mind. Aasheim and Finsen [50Aasheim T, Finsen V. The DASH and the QuickDASH instruments. Normative values in the general population in Norway. J Hand Surg Eur Vol 2014; 39(2): 140-4.
[http://dx.doi.org/10.1177/1753193413481302] [PMID: 23520389]
] found that the mean DASH in women originates from 5 (aged 20-29 years) to 22 (aged 70-79 years) and to 36 (aged over 80 years) whilst in men with similar age groups from 5 to 13 and to 22, and they stated that the QuickDASH should be preferred because it gives the same information, and it is shorter and completed more often. On the other hand, Finsen [51Finsen V. The influence of education and income on responses to the QuickDASH questionnaire. J Hand Surg Eur Vol 2015; 40(4): 401-5.
[http://dx.doi.org/10.1177/1753193414538874] [PMID: 24916634]
] reported for the QuickDASH that socioeconomic factors with female predominance can lead to bias as well, the mean scores for women were 30 for those with the shortest and 9 with the longest education (p < 0.001) whilst for men 19 and 7 (p < 0.001). Poorer self-reported outcomes after wrist injury or surgery related to female predominance were also observed in terms of catastrophic thinking [52Teunis T, Bot AG, Thornton ER, Ring D. Catastrophic Thinking Is Associated With Finger Stiffness After Distal Radius Fracture Surgery. J Orthop Trauma 2015; 29(10): e414-20.
[http://dx.doi.org/10.1097/BOT.0000000000000342] [PMID: 25866942]
], appearance of complex regional pain syndrome [53Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003; 103(1-2): 199-207.
[http://dx.doi.org/10.1016/S0304-3959(03)00065-4] [PMID: 12749974]
-55Crijns TJ, van der Gronde BATD, Ring D, Leung N. Complex regional pain syndrome after distal radius fracture is uncommon and is often associated with fibromyalgia. Clin Orthop Relat Res 2018; 476(4): 744-50.
[http://dx.doi.org/10.1007/s11999.0000000000000070] [PMID: 29419627]
], and women complain wrist malpractice four times more often than men (p < 0.005) and receive five times more frequently financial compensation than men (p < 0.001, mainly based on the causes “operative treatment should have been performed” and “wrong operative method applied”) [56Norum J, Balteskard L, Thomsen MW, Kvernmo HD. Wrist malpractice claims in Northern Norway 2005-2014. Lessons to be learned. Int J Circumpolar Health 2018; 77(1)1483690
[http://dx.doi.org/10.1080/22423982.2018.1483690] [PMID: 29912658]
].

5. COMPARING FUNCTIONAL OUTCOMES OF SALVAGE PROCEDURES AT THE WRIST

5.1. 4CF vs. PRC

Both procedures are indicated in Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC) when radioscaphoid joint alone is involved in arthritic changes (stage II), and 4CF as well when the midcarpal joint is involved additionally (stage III). Scaphoid fracture and scapholunate ligament disruption are mostly injuries of the young or younger active adults with male predominance. If scaphoid fracture is primarily undiagnosed or insufficiently treated, non-union occurs within averaged 8.2 years accompanied by first mostly asymptomatic arthritic changes at the radial styloid (SNAC I) radiographically, followed by symptomatic SNAC II within 17.0 years and SNAC III within 20 years, and SNAC IV (i.e. pancarpal OA, additionally involving radiolunate joint) within 31.6 years [57Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg Am 1984; 66(4): 504-9.
[http://dx.doi.org/10.2106/00004623-198466040-00003] [PMID: 6707028]
, 58Martini AK, Schiltenwolf M. Changes in the wrist joint in spontaneous course of scaphoid pseudarthrosis. Handchir Mikrochir Plast Chir 1995; 27(4): 201-7.
[PMID: 7672731]
]. The only one difference to SLAC is that OA here starts between the proximal scaphoid pole and radioscaphoid fossa in stage I, and not at the radial styloid as in SNAC. Therefore, 4CF and PRC are mostly performed in patients with mean age ranging from 42 to 56 years (range 8 to 84 years), and approximately 75% of them are males (range 53 to 96%) [59Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34(2): 256-63.
[http://dx.doi.org/10.1177/1753193408100954] [PMID: 19369301]
, 60Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40(5): 450-7.
[http://dx.doi.org/10.1177/1753193414554359] [PMID: 25294736]
]. Note that PRC is also an early surgical option for treatment of severe carpal trauma provided, in order to avoid ulnar carpal translocation after surgery, that the volar extrinsic radioscaphocapitate ligament, which is one of the most important stabilizer for the wrist, is not injured [61van Kooten EO, Coster E, Segers MJ, Ritt MJ. Early proximal row carpectomy after severe carpal trauma. Injury 2005; 36(10): 1226-32.
[http://dx.doi.org/10.1016/j.injury.2005.01.005] [PMID: 16214466]
, 62Russchen M, Kachooei AR, Teunis T, Ring D. Acute proximal row carpectomy after complex carpal fracture dislocation. J Hand Microsurg 2015; 7(1): 212-5.
[http://dx.doi.org/10.1007/s12593-014-0162-2] [PMID: 26078546]
]. Ulnar carpal translocation is also known as a rare wrist injury, often initially un- or misdiagnosed due to the unfamiliarity by treating physicians, and, despite primary or secondary ligamentous reconstruction, potentially leading to post-traumatic OA in the majority of all cases within 6.5 years [63Rayhack JM, Linscheid RL, Dobyns JH, Smith JH. Posttraumatic ulnar translation of the carpus. J Hand Surg Am 1987; 12(2): 180-9.
[http://dx.doi.org/10.1016/S0363-5023(87)80268-X] [PMID: 3559067]
-67Schmidt I. Does total wrist arthroplasty for treatment of posttraumatic wrist joint osteoarthritis in young patients always lead to restriction of high-demand activities of daily living? case report and brief review of recent literature. Open Orthop J 2017; 11: 439-46.
[http://dx.doi.org/10.2174/1874325001711010439] [PMID: 28660002]
].

Generally, PRC reveals better self-reported outcomes by the patients, has better functional outcomes, has significantly fewer complications than 4CF such presented as non-union, symptomatic hardware, and hardware failures, and management of non-union after 4CF is challenging [68Brinkhorst ME, Singh HP, Dias JJ, Feitz R, Hovius SER. Comparison of activities of daily living after proximal row carpectomy or wrist four-corner fusion. J Hand Surg Eur Vol 2017; 42(1): 57-62.
[http://dx.doi.org/10.1177/1753193416638812] [PMID: 27016532]
-72Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26(2): 221-8.
[http://dx.doi.org/10.1016/j.hcl.2009.11.003] [PMID: 20494748]
]. Singh et al. [26Singh HP, Brinkhorst ME, Dias JJ, Moojen T, Hovius S, Bhowal B. Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion. J Hand Surg Am 2014; 39(12): 2424-33.
[http://dx.doi.org/10.1016/j.jhsa.2014.09.005] [PMID: 25443170]
] demostrated that the ROM for flexion-extension was 65% of the non-surgical side after PRC vs. 50% only after 4CF, and PRC shows a circumduction curve concentric with the non-surgical wrist. Saltzman et al. [60Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40(5): 450-7.
[http://dx.doi.org/10.1177/1753193414554359] [PMID: 25294736]
] published a systematic review involving seven studies (Levels I-III, 240 patients, 242 wrists) and found significant values after 4CF vs. PRC: extension 39° vs. 43°, flexion 32° vs. 36°, flexion-extension arc 62° vs. 75°, radial deviation 14° vs. 10°, grip strength compared to contralateral 74% vs. 67%, and an overall complication rate of 29% vs. 14%. However, 4CF is not always superior compared to PRC in terms of grip strength despite its significant loss of carpal height [73Laronde P, Christiaens N, Aumar A, Chantelot C, Fontaine C. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study. Hand Surg Rehabil 2016; 35(2): 100-6.
[http://dx.doi.org/10.1016/j.hansur.2016.01.003] [PMID: 27117123]
], and the shape of the proximal capitate pole does not influence the outcome after PRC [74Lenoir H, Toffoli A, Coulet B, Lazerges C, Waitzenegger T, Chammas M. Radiocapitate congruency as a predictive factor for the results of proximal row carpectomy. J Hand Surg Am 2015; 40(6): 1088-94.
[http://dx.doi.org/10.1016/j.jhsa.2015.02.019] [PMID: 25843530]
].

When comparing pre- and postoperative outcome studies, Mulford et al. [59Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34(2): 256-63.
[http://dx.doi.org/10.1177/1753193408100954] [PMID: 19369301]
] found the following values for 4CF vs. PRC: (1) flexion-extension motion arc worsened for both procedures from 79°/81° to 76° (both) associated with worsening of flexion (i.e. in opposite direction of surgical incision) from 39° (both) to 35° (4CF) and 36° (PRC) and extension from 39° to 35° after 4CF whereas extension improved from 38° to 42° after PRC, and (2) ulnar deviation improved for both procedures from 19° to 22° after PRC and from 16° to 17° after 4CF whereas radial deviation worsened for both procedures from 14° to 12° after 4CF and from 13° to 9° after PRC. However, not all of the patients sustaining PRC can be re-employed in their original occupations with heavy manual load [75Ali MH, Rizzo M, Shin AY, Moran SL. Long-term outcomes of proximal row carpectomy: a minimum of 15-year follow-up. Hand (N Y) 2012; 7(1): 72-8.
[http://dx.doi.org/10.1007/s11552-011-9368-y] [PMID: 23449142]
, 76Delclaux S, Israel D, Aprédoaei C, Rongières M, Mansat P. Proximal row carpectomy on manual workers: 17 patients followed for an average of 6 years. Hand Surg Rehabil 2016; 35(6): 401-6.
[http://dx.doi.org/10.1016/j.hansur.2016.09.014] [PMID: 27890248]
]. One main problem after PRC is the appearance of painful impingement between radial styloid and trapezium (Fig. 5 A) which can be avoided by radial styloidectomy [27Blankenhorn BD, Pfaeffle HJ, Tang P, Robertson D, Imbriglia J, Goitz RJ. Carpal kinematics after proximal row carpectomy. J Hand Surg Am 2007; 32(1): 37-46.
[http://dx.doi.org/10.1016/j.jhsa.2006.10.014] [PMID: 17218174]
]. In order to avoid ulnar carpal translocation, radial styloidectomy should be done radial-distal to the origin of the radioscaphocapitate ligament (i.e. level A) (Fig. 5 B) [77Calandruccio JH. Proximal Row Carpectomy. J Am Soc Surg Hand 2001; 1(2): 112-22.
[http://dx.doi.org/10.1053/jssh.2001.23904]
, 78Haefeli M, Borbas P. Radio-scapho-capitate ligament reconstruction during proximal row carpectomy. J Hand Surg Eur Vol 2018; 43(7): 776-8.
[http://dx.doi.org/10.1177/1753193417752319] [PMID: 29359621]
]. Furthermore, PRC is more susceptible for the development of post-traumatic OA than 4CF (Fig. 5 C), but not all of these are clinically of relevance [59Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34(2): 256-63.
[http://dx.doi.org/10.1177/1753193408100954] [PMID: 19369301]
, 79Jebson PJ, Hayes EP, Engber WD. Proximal row carpectomy: A minimum 10-year follow-up study. J Hand Surg Am 2003; 28(4): 561-9.
[http://dx.doi.org/10.1016/S0363-5023(03)00248-X] [PMID: 12877841]
, 80Chim H, Moran SL. Long-term outcomes of proximal row carpectomy: a systematic review of the literature. J Wrist Surg 2012; 1(2): 141-8.
[http://dx.doi.org/10.1055/s-0032-1329547] [PMID: 24179718]
].

Fig. (5)
(A) Painful radial impingement between the radial styloid and trapezium after PRC (arrow). (B) Radial styloidectomy at level A (arrow) is able to avoid radial impingement after PRC. (C) Advanced stage of OA in radiocapitate joint 12 years after PRC, note the pronounced flattening of the proximal capitate pole. Furthermore, a radial styloidectomy was not performed that resulted in an impingement-related advanced stage of OA between radial styloid and trapezium.


Fig. (6)
Same patient as in Figs. (4 A-D and 7 A-E), the course over six years: (A) Initial finding; right primary wrist OA. (B)(E) Within six years postoperatively there was unchanged no loosening of both components. Note the unchanged distance between the tip of the capitate peg and 3rd carpometacarpal joint (ovals) detecting no subsidence of carpal component.


In conclusion, when considering both disadvantages and complications with a large number of 3,388 eligible patients, the conversion rate to TWF is significantly higher with 19.2% after PWF than 4.9% after PRC, and the authors of this study [81Rahgozar P, Zhong L, Chung KC. A comparative analysis of resource utilization between proximal row carpectomy and partial wrist fusion: A population study. J Hand Surg Am 2017; 42(10): 773-80.
[http://dx.doi.org/10.1016/j.jhsa.2017.07.032] [PMID: 28890330]
] stated that there may be a paradigm shift in the current practice patterns for salvage treatment of wrist arthrosis, more often considering PRC for all age groups. Noted that TWA is also a salvage option after failed 4CF or PRC [9Gaspar MP, Lou J, Kane PM, Jacoby SM, Osterman AL, Culp RW. Complications following partial and total wrist Arthroplasty: A Single-Center retrospective review. J Hand Surg Am 2016; 41(1): 47-53.e4.
[http://dx.doi.org/10.1016/j.jhsa.2015.10.021] [PMID: 26710734]
, 82Cooney W, Manuel J, Froelich J, Rizzo M. Total wrist replacement: A retrospective comparative study. J Wrist Surg 2012; 1(2): 165-72.
[http://dx.doi.org/10.1055/s-0032-1326728] [PMID: 24179722]
-84Reigstad O, Holm-Glad T, Bolstad B, Grimsgaard C, Thorkildsen R, Røkkum M. Five- to 10-year prospective follow-up of wrist arthroplasty in 56 nonrheumatoid patients. J Hand Surg Am 2017; 42(10): 788-96.
[http://dx.doi.org/10.1016/j.jhsa.2017.06.097] [PMID: 28844772]
]. Last but not the least, the total costs are 425% greater for 4CF than PRC, implant costs for 4CF alone are 130% greater than the entire surgical encounter for PRC, and costs for plates and staples for 4CF are 70% and 240% greater relative to screws [85Kazmers NH, Stephens AR, Presson AP, Xu Y, Feller RJ, Tyser AR. Comparison of direct surgical costs for proximal row carpectomy and four-corner arthrodesis. J Wrist Surg 2019; 8(1): 66-71.
[http://dx.doi.org/10.1055/s-0038-1675791] [PMID: 30723605]
].

5.2. TWA vs. TWF, AND WRIST DENERVATION

Despite patients receiving TWA report difficulties with “writing”, “picking up small common objects”, “stacking checkers”, “lifting large light objects”, and take twice the time required to complete activities of daily living compared to a normal volunteer [33McCullough M BA, Adams BD, Grosland NM. Postoperative analysis of patients who received the Universal 2 total wrist implant system. J Appl Biomech 2012; 28(4): 466-72.
[http://dx.doi.org/10.1123/jab.28.4.466] [PMID: 22085923]
, 35Singh HP, Bhattacharjee D, Dias JJ, Trail I. Dynamic assessment of the wrist after total wrist arthroplasty. J Hand Surg Eur Vol 2017; 42(6): 573-9.
[http://dx.doi.org/10.1177/1753193417690472] [PMID: 28196435]
], there is evidence in the literature that most of them are satisfied with their maintained or improved function (Figs. 4 A-D) associated with a significantly improved pain relief [32Herzberg G. Total Wrist Arthroplasty: New Perspectives. Curr Rheumatol Rev 2012; 8(4): 239-44.
[http://dx.doi.org/10.2174/157339712805077131]
, 86Boeckstyns ME. Wrist arthroplasty-a systematic review. Dan Med J 2014; 61(5): A4834.
[PMID: 24814740]
]. Moreover, Ekroth et al. [87Ekroth SR, Werner FW, Palmer AK. Case report of long-term results of biaxial and volz total wrist arthroplasty. J Wrist Surg 2012; 1(2): 177-8.
[http://dx.doi.org/10.1055/s-0032-1326730] [PMID: 24179724]
] reported that patients with failed TWAs utilizing older generation types would have a TWA again despite their long-term results being poor and many of them being revised to a TWF.

Recently, rheumatoid arthritis remains the most common indication with a relative portion ranging from 51 to 71% of all patients receiving TWA [86Boeckstyns ME. Wrist arthroplasty-a systematic review. Dan Med J 2014; 61(5): A4834.
[PMID: 24814740]
, 88Melamed E, Marascalchi B, Hinds RM, Rizzo M, Capo JT. Trends in the utilization of total wrist arthroplasty versus wrist fusion fortreatment of advanced wrist arthritis. J Wrist Surg 2016; 5(3): 211-6.
[http://dx.doi.org/10.1055/s-0036-1571841] [PMID: 27468371]
]. From 1,213 patients receiving TWA in the USA from 2001 to 2013 (National Inpatient Sample Database, averaged 100 TWAs per year), 71% were females, and 75% of all patients were aged ranging from 50 to 79 years [89Elbuluk AM, Milone MT, Capo JT, Bosco JA, Klifto CS. Trends and demographics in the utilization of total wrist arthroplasty. J Hand Surg Asian Pac Vol 2018; 23(4): 501-5.
[http://dx.doi.org/10.1142/S2424835518500492] [PMID: 30428787]
]. However, for rheumatoid arthritis the total number of wrist arthroplasties (in total 1,109 procedures in 1,069 patients including TWA and TWF, 83% females, age not available) in the UK has continuously and significantly decreased from 1996 to 2009 by approximately 50% which can be attributed by the effectiveness of the newer antirheumatic drugs [90Dafydd M, Whitaker IS, Murison MS, Boyce DE. Change in operative workload for rheumatoid disease of the hand: 1,109 procedures over 13 years. J Plast Reconstr Aesthet Surg 2012; 65(6): 800-3.
[http://dx.doi.org/10.1016/j.bjps.2011.11.050] [PMID: 22182594]
]. TWA also has proven to be useful as a motion-preserving alternative to TWF for the treatment of post-traumatic wrist OA, primary wrist OA (Figs. 4 A-D and 6 A-E), gout as well as Kienböck’s disease, and resulted in a significantly better outcome than in patients who underwent a primary TWF [8Nydick JA, Watt JF, Garcia MJ, Williams BD, Hess AV. Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 2013; 38(5): 899-903.
[http://dx.doi.org/10.1016/j.jhsa.2013.02.013] [PMID: 23561729]
, 91Boeckstyns ME, Herzberg G, Sørensen AI, et al. Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist? J Wrist Surg 2013; 2(4): 324-9.
[http://dx.doi.org/10.1055/s-0033-1357759] [PMID: 24436837]
-95Schmidt I. Kienböck’s disease mimicing gouty monoarthritis of the wrist. Int J Case Rep Imag 2017; 8(6): 423-6.
[http://dx.doi.org/10.5348/ijcri-201711-LE-10027]
]. TWA for the treatment of post-traumatic wrist OA (including SNAC/SLAC) has reported to be a relative portion of 14% [86Boeckstyns ME. Wrist arthroplasty-a systematic review. Dan Med J 2014; 61(5): A4834.
[PMID: 24814740]
]. TWA is also an option for primary (or early) treatment of highly comminuted distal radius fracture in selected older and elderly patients [96Schmidt I. Can total wrist arthroplasty be an option for treatment of highly comminuted distal radius fracture in selected patients? preliminary experience with two cases. Case Rep Orthop 2015; 2015380935
[http://dx.doi.org/10.1155/2015/380935] [PMID: 26491587]
, 97Morrell NT, Weiss APC. Total Wrist Arthroplasty for Treatment of Distal Radius Fractures. In: Borrelli J, Jr, Anglen JE, Eds. Arthroplasty for Treatment of Fractures in the Older Patient 2018; 81-90.
[http://dx.doi.org/10.1007/978-3-319-94202-5_6]
]. In the literature, no evident data exist regarding patients receiving TWA can load their wrists; Weiss and Akelman [98Weiss AP, Akelman E. Total wrist replacement. Med Health R I 2012; 95(4): 117-9.
[PMID: 22712190]
] advised their eligible patients not to load greater than 10 pounds which contains the implant from a safety perspective. However, there is a trend in literature toward younger patients with good bone stock [67Schmidt I. Does total wrist arthroplasty for treatment of posttraumatic wrist joint osteoarthritis in young patients always lead to restriction of high-demand activities of daily living? case report and brief review of recent literature. Open Orthop J 2017; 11: 439-46.
[http://dx.doi.org/10.2174/1874325001711010439] [PMID: 28660002]
, 84Reigstad O, Holm-Glad T, Bolstad B, Grimsgaard C, Thorkildsen R, Røkkum M. Five- to 10-year prospective follow-up of wrist arthroplasty in 56 nonrheumatoid patients. J Hand Surg Am 2017; 42(10): 788-96.
[http://dx.doi.org/10.1016/j.jhsa.2017.06.097] [PMID: 28844772]
, 88Melamed E, Marascalchi B, Hinds RM, Rizzo M, Capo JT. Trends in the utilization of total wrist arthroplasty versus wrist fusion fortreatment of advanced wrist arthritis. J Wrist Surg 2016; 5(3): 211-6.
[http://dx.doi.org/10.1055/s-0036-1571841] [PMID: 27468371]
].

Recent evidence suggests that the complication rate of all 3rd generation TWAs is significantly lower than older generation types (p=0.002, range 0.1-2.9% vs.0.2-8.1%) [99Berber O, Garagnani L, Gidwani S. Systematic review of total wrist arthroplasty and arthrodesis in wrist arthritis. J Wrist Surg 2018; 7(5): 424-40.
[http://dx.doi.org/10.1055/s-0038-1646956] [PMID: 30349758]
], and its complication rate with 7% is slightly lower as well to those with 10% in patients undergoing a TWF, and TWF is associated with a higher percentage of perioperative device-related complications (6 vs. 3%, p < 0.001) and respiratory complications (0.54 vs. 0%, p < 0.05) potentially leading to higher costs of hospitalization than TWA in 2010 [88Melamed E, Marascalchi B, Hinds RM, Rizzo M, Capo JT. Trends in the utilization of total wrist arthroplasty versus wrist fusion fortreatment of advanced wrist arthritis. J Wrist Surg 2016; 5(3): 211-6.
[http://dx.doi.org/10.1055/s-0036-1571841] [PMID: 27468371]
]. Recently, implant survival with the new 3rd generation TWAs is reported to be 90-100% at five years in most series (Fig. 6 A-E), but it declines from five to eight years [86Boeckstyns ME. Wrist arthroplasty-a systematic review. Dan Med J 2014; 61(5): A4834.
[PMID: 24814740]
]. Mid- to long-term survivorship is 78% for the Universal2, 86% for the Motec, 90% for the Re-Motion, and 95% for the Maestro [99Berber O, Garagnani L, Gidwani S. Systematic review of total wrist arthroplasty and arthrodesis in wrist arthritis. J Wrist Surg 2018; 7(5): 424-40.
[http://dx.doi.org/10.1055/s-0038-1646956] [PMID: 30349758]
], and these results are absolutely comparable with those after partial or total replacements at the shoulder, elbow and ankle which are much less debated in the literature than TWA [100Clough T, Bodo K, Majeed H, Davenport J, Karski M. Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants. Bone Joint J 2019; 101-B(1): 47-54.
[http://dx.doi.org/10.1302/0301-620X.101B1.BJJ-2018-0801.R1] [PMID: 30601052]
-104Maheshwari R, Vaziri S, Helm RH. Total elbow replacement with the Coonrad-Morrey prosthesis: our medium to long-term results. Ann R Coll Surg Engl 2012; 94(3): 189-92.
[http://dx.doi.org/10.1308/003588412X13171221589775] [PMID: 22507725]
]. However, the main problem is an unchanged loosening of its carpal components primarily based on mechanical imbalance and secondarily followed by polyethylene and/or metal wear (Figs. 7 A-B) [105Boeckstyns ME, Toxvaerd A, Bansal M, Vadstrup LS. Wear particles and osteolysis in patients with total wrist arthroplasty. J Hand Surg Am 2014; 39(12): 2396-404.
[http://dx.doi.org/10.1016/j.jhsa.2014.07.046] [PMID: 25227599]
, 106Pfanner S, Munz G, Guidi G, Ceruso M. Universal 2 wrist arthroplasty in rheumatoid arthritis. J Wrist Surg 2017; 6(3): 206-15.
[http://dx.doi.org/10.1055/s-0037-1598637] [PMID: 28725502]
]. Risk factor for appearance of mechanical imbalance is when the carpal component is not correctly aligned in line of the 3rd metacarpal-capitate axis which is the central pillar for load transfer through the wrist, such observed in rheumatoid arthritis with progressive ulnar deviation in carpometacarpal joints (i.e. natural course of rheumatoid arthritis) [106Pfanner S, Munz G, Guidi G, Ceruso M. Universal 2 wrist arthroplasty in rheumatoid arthritis. J Wrist Surg 2017; 6(3): 206-15.
[http://dx.doi.org/10.1055/s-0037-1598637] [PMID: 28725502]
], post-traumatic carpal and/or carpometacarpal malalignment (Figs. 8 A-D) [107Sargazi N, Philpott M, Malik A, Waseem M. Ulna autograft for wrist arthrodesis: A novel approach in failed wrist arthoplasty. Open Orthop J 2017; 11: 768-76.
[http://dx.doi.org/10.2174/1874325001711010768] [PMID: 28979589]
, 108De Smet L, Verhaegen F, Degreef I. Carpal malalignment in malunion of the distal radius and the effect of corrective osteotomy. J Wrist Surg 2014; 3(3): 166-70.
[http://dx.doi.org/10.1055/s-0034-1384823] [PMID: 25097809]
], or iatrogenic (Fig. 9 A-C) [109Ocampos M, Corella F, del Campo B, Carnicer M. Component alignment in total wrist arthroplasty: success rate of surgeons in their first cases. Acta Orthop Traumatol Turc 2014; 48(3): 259-61.
[http://dx.doi.org/10.3944/AOTT.2014.3017] [PMID: 24901914]
].

Fig. (7)
Same patient as in Figs. (4 A-D and 6 A-E: (A) Eight years after TWA, there was evident loosening of carpal Maestro component with cortical migration of the radial-side non-locking screw distally, and loosening with the migration of the ulnar-side non-locking screw proximally into the articular space (red circles). Furthermore, as compared to Figs. (4 B-E), the carpal component is subsided (yellow circle). (B) Typically, the mechanical imbalance of carpal component led to polyethylene wear at the dorsal rim of the insert (yellow arrows), and metal wear originated from the holes of loosened capitate peg and screws, whereas the radial component was sufficiently osseointegrated (light blue arrows). A motion-preserving revision TWA with an exchange of carpal component was wished by the patient, but it was not possible due to the withdrawal of implant by the company. Thus, a TWF had to be performed. For removal of the non-cemented completely osseointegrated radial component, a large dorsal bony windowing at the distal radius became necessary. (C) Intraoperatively, planning the length of the 3,5/2,7 mm Acu-Loc wrist spanning plate (acumed, Hillsboro, Oregon/USA) bridging the large bony defect at the distal radius (pointed line). This plate has proven to be useful for TWF after a failed TWA [107Sargazi N, Philpott M, Malik A, Waseem M. Ulna autograft for wrist arthrodesis: A novel approach in failed wrist arthoplasty. Open Orthop J 2017; 11: 768-76.
[http://dx.doi.org/10.2174/1874325001711010768] [PMID: 28979589]
]. (D) Intraoperative clinical photographs showing the sawed groove into the base of the 3rd metacarpal for placement of a corticocancelleous iliac crest bone graft crossing the 3rd carpometacarpal joint (CMCJ III, pointed line) after debridement of metal debris, and the low-profile 3,5 mm locking fusion plate after its insertion. (E) The TWF was done with the wrist in 15° extension and postoperative radiographs in both planes demonstrating correct placement of fusion plate bridging the large bony defect.


Fig. (8)
59-year-old female sustained right primary combined replacements due to longstanding distal radius physeal arrest, previously published by the author at one- to four-year follow-up with another design of Figures [94Schmidt I. Primary combined replacements for treatment of distal radius physeal arrest. J Wrist Surg 2014; 3(3): 203-5.
[http://dx.doi.org/10.1055/s-0034-1384771] [PMID: 25097815]
, 115Schmidt I. RE-MOTIONTM total wrist arthroplasty for treatmentof advanced stage of scaphoid non-union advancedcollapse. Does excision of the entire scaphoid bone preventimpingement at terminal range of radial deviation? Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000127]
, 118Schmidt I. A critical appraisal to the decision by the company zimmer biomet to withdraw the maestroTM wrist reconstructive system from the marketplace. Trauma Emerg Care 2018; 3(1)
[http://dx.doi.org/10.15761/TEC.1000162]
], recently (six years after surgery), there is unchanged no evident loosening of both implants and the patient is very satisfied with her outcome: (A)
Preoperative radiographs demonstrating severe carpal and carpometacarpal malalignment, and pronounced dorsal tilting of lunate associated with dorsal subluxation of capitate in lunate-capitate joint (green, red, and light blue lines, and light blue points. (B) Intraoperative clinical photograph showing primary combined replacements. (C) Postoperative radiographs demonstrating that the Re-Motion, due to preoperative malalignment, could not be inserted correctly in line of the central 3rd metacarpal-capitate axis (green and red lines). Note that a radial-side diagonal resection of the scaphoid was done in order to avoid radial impingement. (D) Despite a radial-side diagonal resection of scaphoid was performed,there was evident painful radial impingement between the scaphoid and radial TWA component with terminal range of radial deviation (arrow).


Fig. (9)
39-year-old male, left post-traumatic wrist OA after distal radius fracture, TWA with the Universal2, Courtesy by Dr. emeritus Friedbert Kretschmer, Bielefeld/Germany, 2016: (A) Based on the misalignment of both TWA components (i.e. mechanical imbalance), the patient reported progressive disability. (B) Planning revision TWAwith the same implant. (C) Postoperative radiographs demonstrating revision TWA with improved alignments accompanied by improvement of patient’s disability in the further course.


Table 1
Trends in functional outcomes of the 3rd generation TWAs. Data extracted from seven studies with a total number of 334 patients with a minimum follow-up of two years, mean age 59.1 years (total range from 25 to 88 years), and 77.7% (averaged) were females (range 71.8 to 88.7%) [82Cooney W, Manuel J, Froelich J, Rizzo M. Total wrist replacement: A retrospective comparative study. J Wrist Surg 2012; 1(2): 165-72.
[http://dx.doi.org/10.1055/s-0032-1326728] [PMID: 24179722]
, 92Nydick JA, Greenberg SM, Stone JD, Williams B, Polikandriotis JA, Hess AV. Clinical outcomes of total wrist arthroplasty. J Hand Surg Am 2012; 37(8): 1580-4.
[http://dx.doi.org/10.1016/j.jhsa.2012.05.016] [PMID: 22763052]
, 110Morapudi SP, Marlow WJ, Withers D, Ralte P, Gabr A, Waseem M. Total wrist arthroplasty using the Universal 2 prosthesis. J Orthop Surg (Hong Kong) 2012; 20(3): 365-8.
[http://dx.doi.org/10.1177/230949901202000321] [PMID: 23255648]
-114Honecker S, Igeta Y, Al Hefzi A, Pizza C, Facca S, Liverneaux PA. Survival rate on a 10-year follow-up of total wrist replacement implants: A 23-patient case series. J Wrist Surg 2019; 8(1): 24-9.
[http://dx.doi.org/10.1055/s-0038-1668152] [PMID: 30723598]
].



Fig. (10)
Four-years follow-up of male sustained a left Maestro TWA with age of 31 years due to post-traumatic wrist OA, previously published by the author at an one-year follow up [67Schmidt I. Does total wrist arthroplasty for treatment of posttraumatic wrist joint osteoarthritis in young patients always lead to restriction of high-demand activities of daily living? case report and brief review of recent literature. Open Orthop J 2017; 11: 439-46.
[http://dx.doi.org/10.2174/1874325001711010439] [PMID: 28660002]
: (A)
Radiographs in both planes showing no signs of loosening of both Maestro components. (B) The ROM for extension-flexion is 50% of the contralateral uninjured wrist. (C) The "dart-throwing" motion is nearly completely preserved. Circumduction is demonstrated in an additionally attached video (supplementary material). The patient is very satisfied with his outcome, and stated that he would wish a revision Maestro TWA if the implant would loosen in the further course. Unfortunately, that is no longer possible such as described with the other patient in Figs. (7 A-E) [118Schmidt I. A critical appraisal to the decision by the company zimmer biomet to withdraw the maestroTM wrist reconstructive system from the marketplace. Trauma Emerg Care 2018; 3(1)
[http://dx.doi.org/10.15761/TEC.1000162]
, 119Schmidt I. All surgeons who are planning a Total Wrist Arthroplasty with the Maestro TM implants should be aware. Recent Adv Arthroplast 2018; 2(2): 69-74.https://applispublishers.com/wp -content/uploads/2016/07/RAA-02-000115.pdf
[http://dx.doi.org/10.31700/2576-6716.000115]
].


Comparing the functional outcome of the 3rd generation TWAs (Universal2, Re-Motion, Maestro), three trends can be observed (Table 1) [82Cooney W, Manuel J, Froelich J, Rizzo M. Total wrist replacement: A retrospective comparative study. J Wrist Surg 2012; 1(2): 165-72.
[http://dx.doi.org/10.1055/s-0032-1326728] [PMID: 24179722]
, 92Nydick JA, Greenberg SM, Stone JD, Williams B, Polikandriotis JA, Hess AV. Clinical outcomes of total wrist arthroplasty. J Hand Surg Am 2012; 37(8): 1580-4.
[http://dx.doi.org/10.1016/j.jhsa.2012.05.016] [PMID: 22763052]
, 110Morapudi SP, Marlow WJ, Withers D, Ralte P, Gabr A, Waseem M. Total wrist arthroplasty using the Universal 2 prosthesis. J Orthop Surg (Hong Kong) 2012; 20(3): 365-8.
[http://dx.doi.org/10.1177/230949901202000321] [PMID: 23255648]
-114Honecker S, Igeta Y, Al Hefzi A, Pizza C, Facca S, Liverneaux PA. Survival rate on a 10-year follow-up of total wrist replacement implants: A 23-patient case series. J Wrist Surg 2019; 8(1): 24-9.
[http://dx.doi.org/10.1055/s-0038-1668152] [PMID: 30723598]
]: (1) extension and ulnar deviation improved with all types but the Maestro is significantly superior, (2) radial deviation worsened with the Universal2 and the Re-Motion whilst significantly improved with the Maestro, and (3) flexion is equal or worsened for all types compared to preoperative. Impaired radial deviation with the Re-Motion, potentially leading to painful radial impingement despite partial removal of the scaphoid (i.e. radial-side diagonal resection), appears to be an implant-related issue (Fig. 8 D) [94Schmidt I. Primary combined replacements for treatment of distal radius physeal arrest. J Wrist Surg 2014; 3(3): 203-5.
[http://dx.doi.org/10.1055/s-0034-1384771] [PMID: 25097815]
], and it can only be avoided by the removal of the entire scaphoid [115Schmidt I. RE-MOTIONTM total wrist arthroplasty for treatmentof advanced stage of scaphoid non-union advancedcollapse. Does excision of the entire scaphoid bone preventimpingement at terminal range of radial deviation? Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000127]
]. This is similar to PRC before and after radial styloidectomy (Figs. 5 A-B), and reduced carpal height seems to be responsible for that appearance with the Re-Motion as well. In contrast, painful radial impingement is not observed with the Maestro (Fig. 4 A), and it may be justified by preserving resection-related carpal height due to its three various carpal heads combined with it in contrast to the Re-Motion (two carpal heads only, straight design of carpal plate) concave to distal shaped design of carpal plate. Equal or impaired flexion with all types (i.e. in opposite direction of the surgical incision) seems not to be an implant-related but a surgery-related issue. Loss of flexion (i.e. in opposite direction of surgical incision) more than for extension is also observed after 4CF and PRC Figs. (4 A-B and 3 A-B) [59Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34(2): 256-63.
[http://dx.doi.org/10.1177/1753193408100954] [PMID: 19369301]
] as well as in opposite direction of surgical incision for extension after volar plating for the treatment of distal radius fractures [116Kamal RN, Ruch DS. Volar Capsular Release After Distal Radius Fractures. J Hand Surg Am 2017; 42(12): 1034.e1-6.
[http://dx.doi.org/10.1016/j.jhsa.2017.08.002] [PMID: 28917548]
] and for flexion after surgical excision of dorsal wrist ganglions [117Kuliński S, Gutkowska O, Mizia S, Martynkiewicz J, Gosk J. Dorsal and volar wrist ganglions: The results of surgical treatment. Adv Clin Exp Med 2019; 28(1): 95-102.
[http://dx.doi.org/10.17219/acem/81202] [PMID: 30070079]
]. Hence, scar formation around the surgical incision accompanied by loss of elasticity of joint capsule is to be considered generally as a possible predisposition for impaired motion in the opposite direction after surgery.

In conclusion, the Maestro is slightly superior both in terms of survivorship and functional outcome compared to the other 3rd generation TWAs. Despite these findings, the Maestro was withdrawn from the marketplace by the company in 2018, and surgeons have explanation misery to their patients when motion-preserving revision TWA is wished by the patient but not possible anymore by the surgeon (Figs. 7 A-E) [118Schmidt I. A critical appraisal to the decision by the company zimmer biomet to withdraw the maestroTM wrist reconstructive system from the marketplace. Trauma Emerg Care 2018; 3(1)
[http://dx.doi.org/10.15761/TEC.1000162]
, 119Schmidt I. All surgeons who are planning a Total Wrist Arthroplasty with the Maestro TM implants should be aware. Recent Adv Arthroplast 2018; 2(2): 69-74.https://applispublishers.com/wp -content/uploads/2016/07/RAA-02-000115.pdf
[http://dx.doi.org/10.31700/2576-6716.000115]
]. Note that the Maestro provides preservation of the "dart-throwing" motion arc and wrist circumduction in single cases (Figs. (10 A-C), video - attached as supplementary material).

TWF is unchanged a method of choice for primary treatment of traumatic and non-traumatic wrist OA especially for young and younger patients with high claims in their work and leisure [48Wagner ER, Elhassan BT, Kakar S. Long-term functional outcomes after bilateral total wrist arthrodesis. J Hand Surg Am 2015; 40(2): 224-228.e1.
[http://dx.doi.org/10.1016/j.jhsa.2014.10.032] [PMID: 25510154]
, 120de Araujo Silva B, de Souza MV, Carrasco FM, Melo GA, Barreiros LE, Labronici PJ. Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist? Rev Bras Ortop 2015; 50(5): 578-85.
[http://dx.doi.org/10.1016/j.rboe.2015.08.017] [PMID: 26535206]
] as well as a reliable salvage option after a failed 4CF, PRC, and TWA (Fig. 7 A-E) [81Rahgozar P, Zhong L, Chung KC. A comparative analysis of resource utilization between proximal row carpectomy and partial wrist fusion: A population study. J Hand Surg Am 2017; 42(10): 773-80.
[http://dx.doi.org/10.1016/j.jhsa.2017.07.032] [PMID: 28890330]
, 121Reigstad O, Holm-Glad T, Thorkildsen R, Grimsgaard C, Røkkum M. Successful conversion of wrist prosthesis to arthrodesis in 11 patients. J Hand Surg Eur Vol 2017; 42(1): 84-9.
[http://dx.doi.org/10.1177/1753193416674929] [PMID: 27789811]
]. However, patients are limited in performing their activities of daily living. Adey et al. [122Adey L, Ring D, Jupiter JB. Health status after total wrist arthrodesis for posttraumatic arthritis. J Hand Surg Am 2005; 30(5): 932-6.
[http://dx.doi.org/10.1016/j.jhsa.2005.06.004] [PMID: 16182047]
] reported that 20 of 22 patients sustained TWF for treatment of post-traumatic wrist OA would elect to have a procedure that could make their wrist move again if it were available, and 63.6% of them complained wrist pain, including severe pain in four patients. Moreover, when the wrist is fusioned then the extrinsic-related modulation of intrinsic long finger function is lost as well, hence, grip strength is decreased in every instance compared to a hand with a non-fusioned wrist [122Adey L, Ring D, Jupiter JB. Health status after total wrist arthrodesis for posttraumatic arthritis. J Hand Surg Am 2005; 30(5): 932-6.
[http://dx.doi.org/10.1016/j.jhsa.2005.06.004] [PMID: 16182047]
, 123Mühldorfer-Fodor M, Reger A, Schoonhoven Jv, Mittlmeier T, Prommersberger KJ. The effect of midcarpal versus total wrist fusion on the hand’s load distribution during gripping. J Hand Surg Am 2015; 40(11): 2183-90.
[http://dx.doi.org/10.1016/j.jhsa.2015.08.010] [PMID: 26409580]
]. In the literature, it is still controversial about positions in which the wrist should be fusioned. Wagner et al. [48Wagner ER, Elhassan BT, Kakar S. Long-term functional outcomes after bilateral total wrist arthrodesis. J Hand Surg Am 2015; 40(2): 224-228.e1.
[http://dx.doi.org/10.1016/j.jhsa.2014.10.032] [PMID: 25510154]
] reported satisfactory results for bilateral fusions with a mean of 13° ± 9° extension (range from 5° flexion to 30° extension), and a mean difference for right and left of 5° (range 0 to 15°). It has been observed that 30 to 53.6% of patients sustained TWF cannot be successfully re-employed with full use activities in their original occupations [124Weiss AP, Hastings H II. Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application. J Hand Surg Am 1995; 20(1): 50-6.
[http://dx.doi.org/10.1016/S0363-5023(05)80058-9] [PMID: 7722266]
-126De Smet L, Truyen J. Arthrodesis of the wrist for osteoarthritis: outcome with a minimum follow-up of 4 years. J Hand Surg [Br] 2003; 28(6): 575-7.
[http://dx.doi.org/10.1016/S0266-7681(03)00208-0] [PMID: 14599831]
]. The main problem of TWF is persistent mircomotion in the 3rd carpometacarpal joint. Hardware failure (screw or plate loosening or fractures) with 16% is the most common complication after TWF, and 65% of these occurred when the fusion of the 3rd carpometacarpal joint was not additionally done [127Berling SE, Kiefhaber TR, Stern PJ. Hardware-related complications following radiocarpal arthrodesis using a dorsal plate. J Wrist Surg 2015; 4(1): 56-60.
[http://dx.doi.org/10.1055/s-0034-1400069] [PMID: 25709880]
]. Hence, the additional fusion of this joint should be recommended in every instance (Figs. 7 C-E).

Wrist denervation can be combined primarily with PWF/PRC or osteosynthesis of a complex injured wrist [66Schmidt I. Posttraumatic ulnar carpal translocation type Iaccompanied with disruption of the lunotriquetral ligamentcaused by a severe radiocarpal fracture-dislocation injurytype II accompanied with complete luxation of the distalradioulnar joint. What are the salvage options with ist special features in indication when patients developposttraumatic painful wrist joint osteoarthritis? Trauma Emerg Care 2017; 2(4)
[http://dx.doi.org/10.15761/TEC.1000138]
], and is to be considered as a last and sole option in order to reduce pain when both TWA and TWF are technically possible but the patient is unable for these procedures due to particularities in its private and social environment (Figs. 11 A-B) [118Schmidt I. A critical appraisal to the decision by the company zimmer biomet to withdraw the maestroTM wrist reconstructive system from the marketplace. Trauma Emerg Care 2018; 3(1)
[http://dx.doi.org/10.15761/TEC.1000162]
]. Furthermore, the simple and fast denervation of the wrist prior to TWA or TWF in young patients with post-traumatic wrist OA is a suitable and reliable option, does not decrease ROM, has no age limit, preserves grip strength, and still allows other procedures to be performed in the future [67Schmidt I. Does total wrist arthroplasty for treatment of posttraumatic wrist joint osteoarthritis in young patients always lead to restriction of high-demand activities of daily living? case report and brief review of recent literature. Open Orthop J 2017; 11: 439-46.
[http://dx.doi.org/10.2174/1874325001711010439] [PMID: 28660002]
]. Long-term results have been recognized satisfactory pain relief in up to 73% of cases [128Schweizer A, von Känel O, Kammer E, Meuli-Simmen C. Long-term follow-up evaluation of denervation of the wrist. J Hand Surg Am 2006; 31(4): 559-64.
[http://dx.doi.org/10.1016/j.jhsa.2005.12.012] [PMID: 16632048]
-130Hohendorff B, Mühldorfer-Fodor M, Kalb K, von Schoonhoven J, Prommersberger KJ. [Long-term results following denervation of the wrist]. Unfallchirurg 2012; 115(4): 343-52.
[http://dx.doi.org/10.1007/s00113-011-2131-6] [PMID: 22367515]
], and pain relief was stable over time in 89% of cases at a mean follow-up period of 77 months [131Simon E, Zemirline A, Richou J, Hu W, Le Nen D. [Complete wrist denervation: a retrospective study of 27 cases with a mean follow-up period of 77 months]. Chir Main 2012; 31(6): 306-10.
[http://dx.doi.org/10.1016/j.main.2012.07.005] [PMID: 23149002]
]. Noted that patients without advanced stage of wrist OA benefit more from denervation than patients with wrist OA [132Radu CA, Schachner M, Tränkle M, Germann G, Sauerbier M. [Functional results after wrist denervation]. Handchir Mikrochir Plast Chir 2010; 42(5): 279-86.
[http://dx.doi.org/10.1055/s-0030-1249060] [PMID: 20480458]
], but the majority of young patients with high load-bearing occupations cannot be successfully re-employed [133Sgromolo NM, Cho MS, Gower JT, Rhee PC. Partial Wrist Denervation for Idiopathic Dorsal Wrist Pain in an Active Duty Military Population. J Hand Surg Am 2018; 43(12): 1108-12.
[http://dx.doi.org/10.1016/j.jhsa.2018.05.018] [PMID: 29935773]
].

Fig. (11)
(72-year-old female, previously published by the author [118, Copyright: ©2018 Schmidt I.]: (A) Right SNAC IV, unfortunately, she has to take care at home of her bedridden husband after a stroke,and so, she was unable to endure the prolonged time for rehabilitation after TWA or TWF. Hence, the denervation of the wrist was indicated by us. (B) Intraoperative clinical photographs showing the steps for wrist denervation. Two months after surgery, the patient was happy that she was able to perform her activities of daily living with satisfactory pain relief at home again.


LIST OF ABBREVIATIONS

OA = Osteoarthritis
PWF = Partial Wrist Fusion
4CF = Four-Corner Fusion
PRC = Proximal Row Carpectomy
TWA = Total Wrist Arthroplasty
TWF = Total Wrist Fusion
ROM = Range of Motion
DASH = Disability of Arm, Shoulder and Hand
PRWE = Patient-Rated Wrist Evaluation

CONSENT FOR PUBLICATION

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

The author declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

The author would like to thank Dr. Stefan Richard Schiffhauer and Dr. Tino Beylich (both from Hospital Bad Salzungen GmbH, Germany) for their excellent support.

SUPPLEMENTARY MATERIAL

Supplementary material is available on the publishers Website along with the published article.

Download File


REFERENCES

[1] Gupta A. Total wrist arthroplasty. Am J Orthop 2008; 37(8)(Suppl. 1): 12-6.
[PMID: 18836607]
[2] Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985; 10(1): 39-46.
[http://dx.doi.org/10.1016/S0363-5023(85)80246-X] [PMID: 3968403]
[3] Ryu JY, Cooney WP III, Askew LJ, An KN, Chao EY. Functional ranges of motion of the wrist joint. J Hand Surg Am 1991; 16(3): 409-19.
[http://dx.doi.org/10.1016/0363-5023(91)90006-W] [PMID: 1861019]
[4] Brumfield RH, Champoux JA. A biomechanical study of normal functional wrist motion. Clin Orthop Relat Res 1984; (187): 23-5.
[http://dx.doi.org/10.1097/00003086-198407000-00004] [PMID: 6744724]
[5] Volz RG, Lieb M, Benjamin J. Biomechanics of the wrist. Clin Orthop Relat Res 1980; (149): 112-7.
[PMID: 7408289]
[6] Biehl C, Braun T, Thormann U, Oda A, Szalay G, Rehart S. Radiocarpal fusion and midcarpal resection interposition arthroplasty: long-term results in severely destroyed rheumatoid wrists. BMC Musculoskelet Disord 2018; 19(1): 286.
[http://dx.doi.org/10.1186/s12891-018-2172-x] [PMID: 30103715]
[7] De Smet L, Degreef I, Truyen J, Robijns F. Outcome of two salvage procedures for posttraumatic osteoarthritis of the wrist: Arthrodesis or proximal row carpectomy. Acta Chir Belg 2005; 105(6): 626-30.
[http://dx.doi.org/10.1080/00015458.2005.11679790] [PMID: 16438073]
[8] Nydick JA, Watt JF, Garcia MJ, Williams BD, Hess AV. Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 2013; 38(5): 899-903.
[http://dx.doi.org/10.1016/j.jhsa.2013.02.013] [PMID: 23561729]
[9] Gaspar MP, Lou J, Kane PM, Jacoby SM, Osterman AL, Culp RW. Complications following partial and total wrist Arthroplasty: A Single-Center retrospective review. J Hand Surg Am 2016; 41(1): 47-53.e4.
[http://dx.doi.org/10.1016/j.jhsa.2015.10.021] [PMID: 26710734]
[10] Ruby LK, Cooney WP III, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am 1988; 13(1): 1-10.
[http://dx.doi.org/10.1016/0363-5023(88)90189-X] [PMID: 3351212]
[11] Sarrafian SK, Melamed JL, Goshgarian GM. Study of wrist motion in flexion and extension. Clin Orthop Relat Res 1977; (126): 153-9.
[http://dx.doi.org/10.1097/00003086-197707000-00025] [PMID: 598105]
[12] Gellman H, Kauffman D, Lenihan M, Botte MJ, Sarmiento A. An in vitro analysis of wrist motion: The effect of limited intercarpal arthrodesis and the contributions of the radiocarpal and midcarpal joints. J Hand Surg Am 1988; 13(3): 378-83.
[http://dx.doi.org/10.1016/S0363-5023(88)80013-3] [PMID: 3379274]
[13] Kaufmann R, Pfaeffle J, Blankenhorn B, Stabile K, Robertson D, Goitz R. Kinematics of the midcarpal and radiocarpal joints in radioulnar deviation: an in vitro study. J Hand Surg Am 2005; 30(5): 937-42.
[http://dx.doi.org/10.1016/j.jhsa.2005.05.016] [PMID: 16182048]
[14] Andrews JG, Youm Y. A biomechanical investigation of wrist kinematics. J Biomech 1979; 12(1): 83-93.
[http://dx.doi.org/10.1016/0021-9290(79)90012-5] [PMID: 762184]
[15] Leonard L, Sirkett D, Mullineux G, Giddins GE, Miles AW. Development of an in-vivo method of wrist joint motion analysis. Clin Biomech (Bristol, Avon) 2005; 20(2): 166-71.
[http://dx.doi.org/10.1016/j.clinbiomech.2004.09.005] [PMID: 15621321]
[16] Hara T, Horii E, An KN, Cooney WP, Linscheid RL, Chao EY. Force distribution across wrist joint: Application of pressure-sensitive conductive rubber. J Hand Surg Am 1992; 17(2): 339-47.
[http://dx.doi.org/10.1016/0363-5023(92)90417-N] [PMID: 1564285]
[17] Moritomo H, Apergis EP, Garcia-Elias M, Werner FW, Wolfe SW. International Federation of Societies for Surgery of the Hand 2013 Committee’s report on wrist dart-throwing motion. J Hand Surg Am 2014; 39(7): 1433-9.
[http://dx.doi.org/10.1016/j.jhsa.2014.02.035] [PMID: 24888529]
[18] Vardakastani V, Bell H, Mee S, Brigstocke G, Kedgley AE. Clinical measurement of the dart throwing motion of the wrist: Variability, accuracy and correction. J Hand Surg Eur Vol 2018; 43(7): 723-31.
[http://dx.doi.org/10.1177/1753193418773329] [PMID: 29754522]
[19] Kane PM, Vopat BG, Mansuripur PK, et al. Relative contributions of the midcarpal and radiocarpal joints to dart-thrower’s motion at the wrist. J Hand Surg Am 2018; 43(3): 234-40.
[http://dx.doi.org/10.1016/j.jhsa.2017.10.017] [PMID: 29146510]
[20] Crisco JJ, Heard WM, Rich RR, Paller DJ, Wolfe SW. The mechanical axes of the wrist are oriented obliquely to the anatomical axes. J Bone Joint Surg Am 2011; 93(2): 169-77.
[http://dx.doi.org/10.2106/JBJS.I.01222] [PMID: 21248214]
[21] Meyerdierks EM, Mosher JF, Werner FW. Limited wrist arthrodesis: a laboratory study. J Hand Surg Am 1987; 12(4): 526-9.
[http://dx.doi.org/10.1016/S0363-5023(87)80201-0] [PMID: 3611648]
[22] Gíslason MK, Stansfield B, Bransby-Zachary M, Hems T, Nash DH. Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study. J Hand Surg Eur Vol 2012; 37(9): 871-8.
[http://dx.doi.org/10.1177/1753193412441761] [PMID: 22457257]
[23] Li ZM, Kuxhaus L, Fisk JA, Christophel TH. Coupling between wrist flexion-extension and radial-ulnar deviation. Clin Biomech (Bristol, Avon) 2005; 20(2): 177-83.
[http://dx.doi.org/10.1016/j.clinbiomech.2004.10.002] [PMID: 15621323]
[24] Garg R, Kraszewski AP, Stoecklein HH, et al. Wrist kinematic coupling and performance during functional tasks: effects of constrained motion. J Hand Surg Am 2014; 39(4): 634-642.e1.
[http://dx.doi.org/10.1016/j.jhsa.2013.12.031] [PMID: 24582842]
[25] Rust PA, Manojlovich LM, Wallace R. A comparison of dart thrower’s range of motion following radioscapholunate fusion, four-corner fusion and proximal row carpectomy. J Hand Surg Eur Vol 2018; 43(7): 718-22.
[http://dx.doi.org/10.1177/1753193418783330] [PMID: 29950134]
[26] Singh HP, Brinkhorst ME, Dias JJ, Moojen T, Hovius S, Bhowal B. Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion. J Hand Surg Am 2014; 39(12): 2424-33.
[http://dx.doi.org/10.1016/j.jhsa.2014.09.005] [PMID: 25443170]
[27] Blankenhorn BD, Pfaeffle HJ, Tang P, Robertson D, Imbriglia J, Goitz RJ. Carpal kinematics after proximal row carpectomy. J Hand Surg Am 2007; 32(1): 37-46.
[http://dx.doi.org/10.1016/j.jhsa.2006.10.014] [PMID: 17218174]
[28] Tang P, Gauvin J, Muriuki M, Pfaeffle JH, Imbriglia JE, Goitz RJ. Comparison of the “contact biomechanics” of the intact and proximal row carpectomy wrist. J Hand Surg Am 2009; 34(4): 660-70.
[http://dx.doi.org/10.1016/j.jhsa.2008.12.004] [PMID: 19345868]
[29] Schmidt I. Combined replacements using the Maestro total wrist and uHead ulnar head implants. J Hand Surg Eur Vol 2015; 40(7): 754-5.
[http://dx.doi.org/10.1177/1753193414535721] [PMID: 24835474]
[30] Schmidt I. Combined replacements of the wrist, ulnar head, andthumbcarpometacarpal joint. Case report, technical noteand recent evidence to the ArpeTM prosthesis. Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000130]
[31] Werner FW. Wrist Biomechanics: In the normal wrist, following injury and after surgical treatment. Curr Rheumatol Rev 2012; 8(4): 285-7.
[http://dx.doi.org/10.2174/157339712805077159]
[32] Herzberg G. Total Wrist Arthroplasty: New Perspectives. Curr Rheumatol Rev 2012; 8(4): 239-44.
[http://dx.doi.org/10.2174/157339712805077131]
[33] McCullough M BA, Adams BD, Grosland NM. Postoperative analysis of patients who received the Universal 2 total wrist implant system. J Appl Biomech 2012; 28(4): 466-72.
[http://dx.doi.org/10.1123/jab.28.4.466] [PMID: 22085923]
[34] Bajuri MN, Abdul Kadir MR, Murali MR, Kamarul T. Biomechanical analysis of the wrist arthroplasty in rheumatoid arthritis: a finite element analysis. Med Biol Eng Comput 2013; 51(1-2): 175-86.
[http://dx.doi.org/10.1007/s11517-012-0982-9] [PMID: 23124814]
[35] Singh HP, Bhattacharjee D, Dias JJ, Trail I. Dynamic assessment of the wrist after total wrist arthroplasty. J Hand Surg Eur Vol 2017; 42(6): 573-9.
[http://dx.doi.org/10.1177/1753193417690472] [PMID: 28196435]
[36] Reigstad O, Røkkum M. Wrist arthroplasty using prosthesis as an alternative to arthrodesis: design, outcomes and future. J Hand Surg Eur Vol 2018; 43(7): 689-99.
[http://dx.doi.org/10.1177/1753193418784707] [PMID: 29985078]
[37] Adams BD, Grosland NM, Murphy DM, McCullough M. Impact of impaired wrist motion on hand and upper-extremity performance(1). J Hand Surg Am 2003; 28(6): 898-903.
[http://dx.doi.org/10.1016/S0363-5023(03)00424-6] [PMID: 14642503]
[38] Cantero-Téllez R, Orza SG, Bishop MD, Berjano P, Villafañe JH. Duration of wrist immobilization is associated with shoulder pain in patients with after wrist immobilization: An observational study. J Exerc Rehabil 2018; 14(4): 694-8.
[http://dx.doi.org/10.12965/jer.36292.146] [PMID: 30276195]
[39] Weiss AC, Wiedeman G Jr, Quenzer D, Hanington KR, Hastings H II, Strickland JW. Upper extremity function after wrist arthrodesis. J Hand Surg Am 1995; 20(5): 813-7.
[http://dx.doi.org/10.1016/S0363-5023(05)80437-X] [PMID: 8522750]
[40] Jung HY, Chang M, Kim KM, Yoo W, Jeon BJ, Hwang GC. Effect of wrist joint restriction on forearm and shoulder movement during upper extremity functional activities. J Phys Ther Sci 2013; 25(11): 1411-4.
[http://dx.doi.org/10.1589/jpts.25.1411] [PMID: 24396200]
[41] Gomes AD, Macedo Ricci FPF, Zampar AC, Pereira Santiago PR, de Cássia Registro Fonseca M. Influence of static wrist orthosis on muscle activity and shoulder and elbow range of motion during a functional task: a biomechanical study. Fisioter Pesqui 2018; 25(1): 56-64.
[http://dx.doi.org/10.1590/1809-2950/17016425012018]
[42] Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29(6): 602-8.
[http://dx.doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L] [PMID: 8773720]
[43] Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002; 84(2): 208-15.
[http://dx.doi.org/10.2106/00004623-200202000-00007] [PMID: 11861726]
[44] Jester A, Harth A, Wind G, Germann G, Sauerbier M. [Does the disability of shoulder, arm and hand questionnaire (DASH) replace grip strength and range of motion in outcome-evaluation?]. Handchir Mikrochir Plast Chir 2005; 37(2): 126-30.
[http://dx.doi.org/10.1055/s-2004-821279] [PMID: 15877274]
[45] De Smet L. Does restricted wrist motion influence the disability of the upper limb? Acta Orthop Belg 2007; 73(4): 446-50.
[PMID: 17939473]
[46] Dowrick AS, Gabbe BJ, Williamson OD, Cameron PA. Does the disabilities of the arm, shoulder and hand (DASH) scoring system only measure disability due to injuries to the upper limb? J Bone Joint Surg Br 2006; 88(4): 524-7.
[http://dx.doi.org/10.1302/0301-620X.88B4.17223] [PMID: 16567790]
[47] Burgess RA, Thompson RT, Rollman GB. The effect of forearm posture on wrist flexion in computer workers with chronic upper extremity musculoskeletal disorders. BMC Musculoskelet Disord 2008; 9: 47.
[http://dx.doi.org/10.1186/1471-2474-9-47] [PMID: 18405370]
[48] Wagner ER, Elhassan BT, Kakar S. Long-term functional outcomes after bilateral total wrist arthrodesis. J Hand Surg Am 2015; 40(2): 224-228.e1.
[http://dx.doi.org/10.1016/j.jhsa.2014.10.032] [PMID: 25510154]
[49] Yang Z, Lim PPH, Teo SH, Chen H, Qiu H, Pua YH. Association of wrist and forearm range of motion measures with self-reported functional scores amongst patients with distal radius fractures: a longitudinal study. BMC Musculoskelet Disord 2018; 19(1): 142.
[http://dx.doi.org/10.1186/s12891-018-2065-z] [PMID: 29747624]
[50] Aasheim T, Finsen V. The DASH and the QuickDASH instruments. Normative values in the general population in Norway. J Hand Surg Eur Vol 2014; 39(2): 140-4.
[http://dx.doi.org/10.1177/1753193413481302] [PMID: 23520389]
[51] Finsen V. The influence of education and income on responses to the QuickDASH questionnaire. J Hand Surg Eur Vol 2015; 40(4): 401-5.
[http://dx.doi.org/10.1177/1753193414538874] [PMID: 24916634]
[52] Teunis T, Bot AG, Thornton ER, Ring D. Catastrophic Thinking Is Associated With Finger Stiffness After Distal Radius Fracture Surgery. J Orthop Trauma 2015; 29(10): e414-20.
[http://dx.doi.org/10.1097/BOT.0000000000000342] [PMID: 25866942]
[53] Sandroni P, Benrud-Larson LM, McClelland RL, Low PA. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003; 103(1-2): 199-207.
[http://dx.doi.org/10.1016/S0304-3959(03)00065-4] [PMID: 12749974]
[54] de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. Pain 2007; 129(1-2): 12-20.
[http://dx.doi.org/10.1016/j.pain.2006.09.008] [PMID: 17084977]
[55] Crijns TJ, van der Gronde BATD, Ring D, Leung N. Complex regional pain syndrome after distal radius fracture is uncommon and is often associated with fibromyalgia. Clin Orthop Relat Res 2018; 476(4): 744-50.
[http://dx.doi.org/10.1007/s11999.0000000000000070] [PMID: 29419627]
[56] Norum J, Balteskard L, Thomsen MW, Kvernmo HD. Wrist malpractice claims in Northern Norway 2005-2014. Lessons to be learned. Int J Circumpolar Health 2018; 77(1)1483690
[http://dx.doi.org/10.1080/22423982.2018.1483690] [PMID: 29912658]
[57] Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg Am 1984; 66(4): 504-9.
[http://dx.doi.org/10.2106/00004623-198466040-00003] [PMID: 6707028]
[58] Martini AK, Schiltenwolf M. Changes in the wrist joint in spontaneous course of scaphoid pseudarthrosis. Handchir Mikrochir Plast Chir 1995; 27(4): 201-7.
[PMID: 7672731]
[59] Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34(2): 256-63.
[http://dx.doi.org/10.1177/1753193408100954] [PMID: 19369301]
[60] Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40(5): 450-7.
[http://dx.doi.org/10.1177/1753193414554359] [PMID: 25294736]
[61] van Kooten EO, Coster E, Segers MJ, Ritt MJ. Early proximal row carpectomy after severe carpal trauma. Injury 2005; 36(10): 1226-32.
[http://dx.doi.org/10.1016/j.injury.2005.01.005] [PMID: 16214466]
[62] Russchen M, Kachooei AR, Teunis T, Ring D. Acute proximal row carpectomy after complex carpal fracture dislocation. J Hand Microsurg 2015; 7(1): 212-5.
[http://dx.doi.org/10.1007/s12593-014-0162-2] [PMID: 26078546]
[63] Rayhack JM, Linscheid RL, Dobyns JH, Smith JH. Posttraumatic ulnar translation of the carpus. J Hand Surg Am 1987; 12(2): 180-9.
[http://dx.doi.org/10.1016/S0363-5023(87)80268-X] [PMID: 3559067]
[64] Song D, Goodman S, Gilula LA, Wollstein R. Ulnocarpal translation in perilunate dislocations. J Hand Surg Eur Vol 2009; 34(3): 388-90.
[http://dx.doi.org/10.1177/1753193409103093] [PMID: 19457905]
[65] Berschback JC, Kalainov DM, Husain SN, Wiedrich TA, Cohen MS, Nagle DJ. Traumatic ulnar translocation of the carpus: early recognition and treatment. J Hand Surg Eur Vol 2012; 37(8): 755-64.
[http://dx.doi.org/10.1177/1753193412436626] [PMID: 22357328]
[66] Schmidt I. Posttraumatic ulnar carpal translocation type Iaccompanied with disruption of the lunotriquetral ligamentcaused by a severe radiocarpal fracture-dislocation injurytype II accompanied with complete luxation of the distalradioulnar joint. What are the salvage options with ist special features in indication when patients developposttraumatic painful wrist joint osteoarthritis? Trauma Emerg Care 2017; 2(4)
[http://dx.doi.org/10.15761/TEC.1000138]
[67] Schmidt I. Does total wrist arthroplasty for treatment of posttraumatic wrist joint osteoarthritis in young patients always lead to restriction of high-demand activities of daily living? case report and brief review of recent literature. Open Orthop J 2017; 11: 439-46.
[http://dx.doi.org/10.2174/1874325001711010439] [PMID: 28660002]
[68] Brinkhorst ME, Singh HP, Dias JJ, Feitz R, Hovius SER. Comparison of activities of daily living after proximal row carpectomy or wrist four-corner fusion. J Hand Surg Eur Vol 2017; 42(1): 57-62.
[http://dx.doi.org/10.1177/1753193416638812] [PMID: 27016532]
[69] Wagner ER, Werthel JD, Elhassan BT, Moran SL. Proximal row carpectomy and 4-Corner arthrodesis in patients younger than age 45 years. J Hand Surg Am 2017; 42(6): 428-35.
[http://dx.doi.org/10.1016/j.jhsa.2017.03.015] [PMID: 28410937]
[70] Williams JB, Weiner H, Tyser AR. Long-term outcome and secondary operations after proximal row carpectomy or four-corner arthrodesis. J Wrist Surg 2018; 7(1): 51-6.
[http://dx.doi.org/10.1055/s-0037-1604395] [PMID: 29383276]
[71] Skie MC, Gove N, Ciocanel DE, Smith H. Management of non-united four-corner fusions. Hand (N Y) 2007; 2(1): 34-8.
[http://dx.doi.org/10.1007/s11552-007-9021-y] [PMID: 18780046]
[72] Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26(2): 221-8.
[http://dx.doi.org/10.1016/j.hcl.2009.11.003] [PMID: 20494748]
[73] Laronde P, Christiaens N, Aumar A, Chantelot C, Fontaine C. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study. Hand Surg Rehabil 2016; 35(2): 100-6.
[http://dx.doi.org/10.1016/j.hansur.2016.01.003] [PMID: 27117123]
[74] Lenoir H, Toffoli A, Coulet B, Lazerges C, Waitzenegger T, Chammas M. Radiocapitate congruency as a predictive factor for the results of proximal row carpectomy. J Hand Surg Am 2015; 40(6): 1088-94.
[http://dx.doi.org/10.1016/j.jhsa.2015.02.019] [PMID: 25843530]
[75] Ali MH, Rizzo M, Shin AY, Moran SL. Long-term outcomes of proximal row carpectomy: a minimum of 15-year follow-up. Hand (N Y) 2012; 7(1): 72-8.
[http://dx.doi.org/10.1007/s11552-011-9368-y] [PMID: 23449142]
[76] Delclaux S, Israel D, Aprédoaei C, Rongières M, Mansat P. Proximal row carpectomy on manual workers: 17 patients followed for an average of 6 years. Hand Surg Rehabil 2016; 35(6): 401-6.
[http://dx.doi.org/10.1016/j.hansur.2016.09.014] [PMID: 27890248]
[77] Calandruccio JH. Proximal Row Carpectomy. J Am Soc Surg Hand 2001; 1(2): 112-22.
[http://dx.doi.org/10.1053/jssh.2001.23904]
[78] Haefeli M, Borbas P. Radio-scapho-capitate ligament reconstruction during proximal row carpectomy. J Hand Surg Eur Vol 2018; 43(7): 776-8.
[http://dx.doi.org/10.1177/1753193417752319] [PMID: 29359621]
[79] Jebson PJ, Hayes EP, Engber WD. Proximal row carpectomy: A minimum 10-year follow-up study. J Hand Surg Am 2003; 28(4): 561-9.
[http://dx.doi.org/10.1016/S0363-5023(03)00248-X] [PMID: 12877841]
[80] Chim H, Moran SL. Long-term outcomes of proximal row carpectomy: a systematic review of the literature. J Wrist Surg 2012; 1(2): 141-8.
[http://dx.doi.org/10.1055/s-0032-1329547] [PMID: 24179718]
[81] Rahgozar P, Zhong L, Chung KC. A comparative analysis of resource utilization between proximal row carpectomy and partial wrist fusion: A population study. J Hand Surg Am 2017; 42(10): 773-80.
[http://dx.doi.org/10.1016/j.jhsa.2017.07.032] [PMID: 28890330]
[82] Cooney W, Manuel J, Froelich J, Rizzo M. Total wrist replacement: A retrospective comparative study. J Wrist Surg 2012; 1(2): 165-72.
[http://dx.doi.org/10.1055/s-0032-1326728] [PMID: 24179722]
[83] Schmidt I. An Unusual and Complicated Course of a Giant Cell Tumor of the Capitate Bone. Case Rep Orthop 2016; 20163705808
[http://dx.doi.org/10.1155/2016/3705808] [PMID: 27847665]
[84] Reigstad O, Holm-Glad T, Bolstad B, Grimsgaard C, Thorkildsen R, Røkkum M. Five- to 10-year prospective follow-up of wrist arthroplasty in 56 nonrheumatoid patients. J Hand Surg Am 2017; 42(10): 788-96.
[http://dx.doi.org/10.1016/j.jhsa.2017.06.097] [PMID: 28844772]
[85] Kazmers NH, Stephens AR, Presson AP, Xu Y, Feller RJ, Tyser AR. Comparison of direct surgical costs for proximal row carpectomy and four-corner arthrodesis. J Wrist Surg 2019; 8(1): 66-71.
[http://dx.doi.org/10.1055/s-0038-1675791] [PMID: 30723605]
[86] Boeckstyns ME. Wrist arthroplasty-a systematic review. Dan Med J 2014; 61(5): A4834.
[PMID: 24814740]
[87] Ekroth SR, Werner FW, Palmer AK. Case report of long-term results of biaxial and volz total wrist arthroplasty. J Wrist Surg 2012; 1(2): 177-8.
[http://dx.doi.org/10.1055/s-0032-1326730] [PMID: 24179724]
[88] Melamed E, Marascalchi B, Hinds RM, Rizzo M, Capo JT. Trends in the utilization of total wrist arthroplasty versus wrist fusion fortreatment of advanced wrist arthritis. J Wrist Surg 2016; 5(3): 211-6.
[http://dx.doi.org/10.1055/s-0036-1571841] [PMID: 27468371]
[89] Elbuluk AM, Milone MT, Capo JT, Bosco JA, Klifto CS. Trends and demographics in the utilization of total wrist arthroplasty. J Hand Surg Asian Pac Vol 2018; 23(4): 501-5.
[http://dx.doi.org/10.1142/S2424835518500492] [PMID: 30428787]
[90] Dafydd M, Whitaker IS, Murison MS, Boyce DE. Change in operative workload for rheumatoid disease of the hand: 1,109 procedures over 13 years. J Plast Reconstr Aesthet Surg 2012; 65(6): 800-3.
[http://dx.doi.org/10.1016/j.bjps.2011.11.050] [PMID: 22182594]
[91] Boeckstyns ME, Herzberg G, Sørensen AI, et al. Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist? J Wrist Surg 2013; 2(4): 324-9.
[http://dx.doi.org/10.1055/s-0033-1357759] [PMID: 24436837]
[92] Nydick JA, Greenberg SM, Stone JD, Williams B, Polikandriotis JA, Hess AV. Clinical outcomes of total wrist arthroplasty. J Hand Surg Am 2012; 37(8): 1580-4.
[http://dx.doi.org/10.1016/j.jhsa.2012.05.016] [PMID: 22763052]
[93] Schmidt I. The MaestroTM wrist reconstructive system for treatmentof posttraumatic wrist joint osteoarthritis after a devastingcourse of a distal radius fracture: Case presentation andtechnical note to the implant. Trauma Emerg Care 2017; 2(1)
[http://dx.doi.org/10.15761/TEC.1000124]
[94] Schmidt I. Primary combined replacements for treatment of distal radius physeal arrest. J Wrist Surg 2014; 3(3): 203-5.
[http://dx.doi.org/10.1055/s-0034-1384771] [PMID: 25097815]
[95] Schmidt I. Kienböck’s disease mimicing gouty monoarthritis of the wrist. Int J Case Rep Imag 2017; 8(6): 423-6.
[http://dx.doi.org/10.5348/ijcri-201711-LE-10027]
[96] Schmidt I. Can total wrist arthroplasty be an option for treatment of highly comminuted distal radius fracture in selected patients? preliminary experience with two cases. Case Rep Orthop 2015; 2015380935
[http://dx.doi.org/10.1155/2015/380935] [PMID: 26491587]
[97] Morrell NT, Weiss APC. Total Wrist Arthroplasty for Treatment of Distal Radius Fractures. In: Borrelli J, Jr, Anglen JE, Eds. Arthroplasty for Treatment of Fractures in the Older Patient 2018; 81-90.
[http://dx.doi.org/10.1007/978-3-319-94202-5_6]
[98] Weiss AP, Akelman E. Total wrist replacement. Med Health R I 2012; 95(4): 117-9.
[PMID: 22712190]
[99] Berber O, Garagnani L, Gidwani S. Systematic review of total wrist arthroplasty and arthrodesis in wrist arthritis. J Wrist Surg 2018; 7(5): 424-40.
[http://dx.doi.org/10.1055/s-0038-1646956] [PMID: 30349758]
[100] Clough T, Bodo K, Majeed H, Davenport J, Karski M. Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants. Bone Joint J 2019; 101-B(1): 47-54.
[http://dx.doi.org/10.1302/0301-620X.101B1.BJJ-2018-0801.R1] [PMID: 30601052]
[101] Robinson WA, Wagner ER, Cofield RH, Sánchez-Sotelo J, Sperling JW. Long-term outcomes of humeral head replacement for the treatment of osteoarthritis; a report of 44 arthroplasties with minimum 10-year follow-up. J Shoulder Elbow Surg 2018; 27(5): 846-52.
[http://dx.doi.org/10.1016/j.jse.2017.10.017] [PMID: 29269140]
[102] Ernstbrunner L, Hingsammer A, Imam MA, et al. Long-term results of total elbow arthroplasty in patients with hemophilia. J Shoulder Elbow Surg 2018; 27(1): 126-32.
[http://dx.doi.org/10.1016/j.jse.2017.09.009] [PMID: 29103812]
[103] Schöni M, Drerup S, Angst F, Kyburz D, Simmen BR, Goldhahn J. Long-term survival of GSB III elbow prostheses and risk factors for revisions. Arch Orthop Trauma Surg 2013; 133(10): 1415-24.
[http://dx.doi.org/10.1007/s00402-013-1815-5] [PMID: 23864158]
[104] Maheshwari R, Vaziri S, Helm RH. Total elbow replacement with the Coonrad-Morrey prosthesis: our medium to long-term results. Ann R Coll Surg Engl 2012; 94(3): 189-92.
[http://dx.doi.org/10.1308/003588412X13171221589775] [PMID: 22507725]
[105] Boeckstyns ME, Toxvaerd A, Bansal M, Vadstrup LS. Wear particles and osteolysis in patients with total wrist arthroplasty. J Hand Surg Am 2014; 39(12): 2396-404.
[http://dx.doi.org/10.1016/j.jhsa.2014.07.046] [PMID: 25227599]
[106] Pfanner S, Munz G, Guidi G, Ceruso M. Universal 2 wrist arthroplasty in rheumatoid arthritis. J Wrist Surg 2017; 6(3): 206-15.
[http://dx.doi.org/10.1055/s-0037-1598637] [PMID: 28725502]
[107] Sargazi N, Philpott M, Malik A, Waseem M. Ulna autograft for wrist arthrodesis: A novel approach in failed wrist arthoplasty. Open Orthop J 2017; 11: 768-76.
[http://dx.doi.org/10.2174/1874325001711010768] [PMID: 28979589]
[108] De Smet L, Verhaegen F, Degreef I. Carpal malalignment in malunion of the distal radius and the effect of corrective osteotomy. J Wrist Surg 2014; 3(3): 166-70.
[http://dx.doi.org/10.1055/s-0034-1384823] [PMID: 25097809]
[109] Ocampos M, Corella F, del Campo B, Carnicer M. Component alignment in total wrist arthroplasty: success rate of surgeons in their first cases. Acta Orthop Traumatol Turc 2014; 48(3): 259-61.
[http://dx.doi.org/10.3944/AOTT.2014.3017] [PMID: 24901914]
[110] Morapudi SP, Marlow WJ, Withers D, Ralte P, Gabr A, Waseem M. Total wrist arthroplasty using the Universal 2 prosthesis. J Orthop Surg (Hong Kong) 2012; 20(3): 365-8.
[http://dx.doi.org/10.1177/230949901202000321] [PMID: 23255648]
[111] Boeckstyns ME, Herzberg G, Merser S. Favorable results after total wrist arthroplasty: 65 wrists in 60 patients followed for 5–9 years. Acta Orthop 2013; 84(4): 415-9.
[http://dx.doi.org/10.3109/17453674.2013.823588] [PMID: 23848216]
[112] Sagerfors M, Gupta A, Brus O, Rizzo M, Pettersson K. Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases. Hand Surg 2015; 20(1): 81-7.
[http://dx.doi.org/10.1142/S0218810415500112] [PMID: 25609279]
[113] Badge R, Kailash K, Dickson DR, et al. Medium-term outcomes of the Universal-2 total wrist arthroplasty in patients with rheumatoid arthritis. Bone Joint J 2016; 98-B(12): 1642-7.
[http://dx.doi.org/10.1302/0301-620X.98B12.37121] [PMID: 27909126]
[114] Honecker S, Igeta Y, Al Hefzi A, Pizza C, Facca S, Liverneaux PA. Survival rate on a 10-year follow-up of total wrist replacement implants: A 23-patient case series. J Wrist Surg 2019; 8(1): 24-9.
[http://dx.doi.org/10.1055/s-0038-1668152] [PMID: 30723598]
[115] Schmidt I. RE-MOTIONTM total wrist arthroplasty for treatmentof advanced stage of scaphoid non-union advancedcollapse. Does excision of the entire scaphoid bone preventimpingement at terminal range of radial deviation? Trauma Emerg Care 2017; 2(2)
[http://dx.doi.org/10.15761/TEC.1000127]
[116] Kamal RN, Ruch DS. Volar Capsular Release After Distal Radius Fractures. J Hand Surg Am 2017; 42(12): 1034.e1-6.
[http://dx.doi.org/10.1016/j.jhsa.2017.08.002] [PMID: 28917548]
[117] Kuliński S, Gutkowska O, Mizia S, Martynkiewicz J, Gosk J. Dorsal and volar wrist ganglions: The results of surgical treatment. Adv Clin Exp Med 2019; 28(1): 95-102.
[http://dx.doi.org/10.17219/acem/81202] [PMID: 30070079]
[118] Schmidt I. A critical appraisal to the decision by the company zimmer biomet to withdraw the maestroTM wrist reconstructive system from the marketplace. Trauma Emerg Care 2018; 3(1)
[http://dx.doi.org/10.15761/TEC.1000162]
[119] Schmidt I. All surgeons who are planning a Total Wrist Arthroplasty with the Maestro TM implants should be aware. Recent Adv Arthroplast 2018; 2(2): 69-74.https://applispublishers.com/wp -content/uploads/2016/07/RAA-02-000115.pdf
[http://dx.doi.org/10.31700/2576-6716.000115]
[120] de Araujo Silva B, de Souza MV, Carrasco FM, Melo GA, Barreiros LE, Labronici PJ. Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist? Rev Bras Ortop 2015; 50(5): 578-85.
[http://dx.doi.org/10.1016/j.rboe.2015.08.017] [PMID: 26535206]
[121] Reigstad O, Holm-Glad T, Thorkildsen R, Grimsgaard C, Røkkum M. Successful conversion of wrist prosthesis to arthrodesis in 11 patients. J Hand Surg Eur Vol 2017; 42(1): 84-9.
[http://dx.doi.org/10.1177/1753193416674929] [PMID: 27789811]
[122] Adey L, Ring D, Jupiter JB. Health status after total wrist arthrodesis for posttraumatic arthritis. J Hand Surg Am 2005; 30(5): 932-6.
[http://dx.doi.org/10.1016/j.jhsa.2005.06.004] [PMID: 16182047]
[123] Mühldorfer-Fodor M, Reger A, Schoonhoven Jv, Mittlmeier T, Prommersberger KJ. The effect of midcarpal versus total wrist fusion on the hand’s load distribution during gripping. J Hand Surg Am 2015; 40(11): 2183-90.
[http://dx.doi.org/10.1016/j.jhsa.2015.08.010] [PMID: 26409580]
[124] Weiss AP, Hastings H II. Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application. J Hand Surg Am 1995; 20(1): 50-6.
[http://dx.doi.org/10.1016/S0363-5023(05)80058-9] [PMID: 7722266]
[125] Sauerbier M, Kluge S, Bickert B, Germann G. Subjective and objective outcomes after total wrist arthrodesis in patients with radiocarpal arthrosis or Kienböck’s disease. Chir Main 2000; 19(4): 223-31.
[http://dx.doi.org/10.1016/S1297-3203(00)73484-6] [PMID: 11079179]
[126] De Smet L, Truyen J. Arthrodesis of the wrist for osteoarthritis: outcome with a minimum follow-up of 4 years. J Hand Surg [Br] 2003; 28(6): 575-7.
[http://dx.doi.org/10.1016/S0266-7681(03)00208-0] [PMID: 14599831]
[127] Berling SE, Kiefhaber TR, Stern PJ. Hardware-related complications following radiocarpal arthrodesis using a dorsal plate. J Wrist Surg 2015; 4(1): 56-60.
[http://dx.doi.org/10.1055/s-0034-1400069] [PMID: 25709880]
[128] Schweizer A, von Känel O, Kammer E, Meuli-Simmen C. Long-term follow-up evaluation of denervation of the wrist. J Hand Surg Am 2006; 31(4): 559-64.
[http://dx.doi.org/10.1016/j.jhsa.2005.12.012] [PMID: 16632048]
[129] Rothe M, Rudolf KD, Partecke BD. [Long-term results following denervation of the wrist in patients with stages II and III SLAC-/SNAC-wrist]. Handchir Mikrochir Plast Chir 2006; 38(4): 261-6.
[http://dx.doi.org/10.1055/s-2006-924408] [PMID: 16991047]
[130] Hohendorff B, Mühldorfer-Fodor M, Kalb K, von Schoonhoven J, Prommersberger KJ. [Long-term results following denervation of the wrist]. Unfallchirurg 2012; 115(4): 343-52.
[http://dx.doi.org/10.1007/s00113-011-2131-6] [PMID: 22367515]
[131] Simon E, Zemirline A, Richou J, Hu W, Le Nen D. [Complete wrist denervation: a retrospective study of 27 cases with a mean follow-up period of 77 months]. Chir Main 2012; 31(6): 306-10.
[http://dx.doi.org/10.1016/j.main.2012.07.005] [PMID: 23149002]
[132] Radu CA, Schachner M, Tränkle M, Germann G, Sauerbier M. [Functional results after wrist denervation]. Handchir Mikrochir Plast Chir 2010; 42(5): 279-86.
[http://dx.doi.org/10.1055/s-0030-1249060] [PMID: 20480458]
[133] Sgromolo NM, Cho MS, Gower JT, Rhee PC. Partial Wrist Denervation for Idiopathic Dorsal Wrist Pain in an Active Duty Military Population. J Hand Surg Am 2018; 43(12): 1108-12.
[http://dx.doi.org/10.1016/j.jhsa.2018.05.018] [PMID: 29935773]

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open