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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 October;59(5):283-98
“Regressive” patho-mechanics of distal radial fractures and savage by reconstruction of Coxa Manus
Grippi G. M.
Struttura Ospedaliera Semplice di Chirurgia della Mano Struttura Ospedaliera Complessa di Ortopedia e Traumatologia Ospedale San Lazzaro di Alba ASL CN2 del Piemonte, Alba, Cuneo, Italia
Aim. Frequent outcome of distal radius fractures (DRF) is radio-carpal stiffness, with spontaneous reset of carpal kinetics so the residual movement is transferred in the medio-carpal joint, on the capitate’s head. This opportunity is an interesting adaptation to trauma, produced by evolution during philogenesis of primate’s anterior autopod towards the particular order of human Carpus. In fact, according to Biarticular Concentric Carpal Mechanism, wrist architecture is similar to the femur biarticular prosthesis, which contains the center of rotation (CR) reproduced by the capitate’s head. Comparably, the capitate on scaphoid and lunate constitutes an enarthrosis in the Carpus center: the Coxa Manus (CM), the “real” and older carpal joint. That is discussed origin, in philogenesis and during primate brachiation, by evidences proving the carpal condile and radio-carpal joint to be recent acquisitions, secondary and no essential in wrist movement. These concepts reappraise the need to recover the damaged radio-carpal joint. In other terms, using aforesaid adaptation in the suffering post-DRF wrist, the joint can be surgical sacrificed; a valid option is “to simplify the carpal function” by concentrating the movement in the CM.
Methods. The surgical treatment of Coxa Manus Reconstruction (CMR) follows this way, and consists in a radius-lunate-emiscaphoid arthrodesis that moulds an “ancestral” CM changed in only joint of Carpus and with its CR definitively stabilized, similar to the Teropod Maniraptors wrist joint. To support the initial proposition, 9 operated cases are introduced (of which, four are shown in detail into exemplify the indications and clinical outcome).
Results. The results (assessed according to the parameters of the Mayo Wrist Score Chart, with a 2.8 year average follow-up) have been satisfactory in all cases.
Conclusion. In suffering post-DRF wrist, the CMR has proved to be valid savage operation, able to perfect Nature’s carpus adaptation in the trauma, with reliable and satisfactory results.