Spasticité et neuro orthopédie
Le 14/10/2021 de 14:30 à 16:00
Arthrodèse raccourcissante du poignet par clou de Rush chez l'adulte spastique : une série de 15 cas
Victor Lestienne (Lille, France), Valentin Oca (Lille, France), Alexandre Cornu (Lille, France), Christian Fontaine (Lille, France), Etienne Allart (Lille, France), Nadine Sturbois-Nachef (Lille, France)
Objective : In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe, fixed flexion contracture. The most commonly used technique is dorsal plate osteosynthesis. Ideally, low-volume osteosynthesis further from the tendons would limit postoperative tendon adhesions and reoperation rates for hardware removal. The objective of our study was to evaluate the efficacy of Rush pin SWA in adults.
Material / Patients and Methods : In a retrospective study, we included all patients with a central neurological impairment, having undergone SWA using a Rush pin inserted through the head of the third metacarpal, and with at least 6 months of follow-up. Attainment of the preoperative objectives was evaluated in a global assessment of response to treatment (GART, ranging from -4 to +4) and, for functional objectives, the House score and the Frenchay Arm Test. Consolidation and the possible presence of degenerative changes in the third metacarpophalangeal joint was assessed on an X-ray.
Results : Fifteen patients were included, with a mean follow-up of 13 months (6-29). In general, the preoperative objectives were attained: the mean GART was 2.7 (1-4). Functional objectives were attained in three patients (27%). In all cases, the bone had consolidated after an average of 74 days (39-102). Three patients had hardware removed after consolidation (due in one case to discomfort at the head of the third metacarpal).
Discussion - Conclusion : Rush pin arthrodesis is an interesting alternative to plate arthrodesis in the management of severe wrist flexion contracture in spastic patients. It gives satisfactory results with regard to preoperative objectives and is not associated with complications.
Keywords : arthrodesis; wrist; Rush pin; spastic wrist; cerebral palsy
Disclosure of interest : Aucun