International Conference On Orthopedics And Sports Medicine

 

                                  On orthopedics surgeon specializing in hand and upper extremity surgery at Mayo Clinic's campus in Florida, first saw the young basketball player, he noted the boy was not experiencing pain, yet had significant issues with range of motion (ROM).

                                 "He had a pothole in his wrist joint," he says. "His wrist fracture healed in a bad position — and the carpal bones were stuck in the hole.

                                  The reason for the hole present in the boy's wrist joint was an impaction fracture. It was not initially recognized and progressed to a malunion.

 

              

                                        

  

                                Distinct from a nonunion, where there is no healing in the joint, a malunion indicates nonanatomic healing, which can be a complication from surgery or something that occurs when nonsurgical management doesn't maintain the appropriate position of the bones.

                                In the young basketball player's case, no surgery had been performed on his wrist initially, as his health care providers at the time did not recognize the extent of injury. He had a different injury pattern from what is commonly seen in the wrist. In this case, only one part of the joint surface was affected — appearing almost like a die punch in that location — where typical wrist injuries either impact a larger portion of the joint or are outside of the joint altogether. This was a fracture in the scaphoid fossa, part of the joint that supports the scaphoid bone. Though small, this injury and its subsequent malunion caused swelling and limited use of the wrist. In some patients, a wrist malunion can cause the wrist joint to become completely unusable.

Traditional versus cartilage graft wrist fracture repair

                   A traditional wrist fracture repair would include an osteotomy. However, this procedure, with its usual bone cutting and removal, would be difficult to perform in a contained defect in a small area of the joint surface, says Dr. Aziz.

Due to the nature of the malunion in the basketball player's case, Dr. Aziz elected to take a knee cartilage graft in a non-weight-bearing region to repair the wrist joint. Though this was a unique repair for the player's injury, his parents agreed to pursue it. As the young patient was still skeletally immature with his growth plates

Applications of the knee cartilage graft for wrist malunion repair

                   Surgeons can perform the same type of knee cartilage graft for wrist malunion for adults as the basketball player experienced. The procedure is easier to perform in this population — considering future growth is not necessary, as it is in pediatric patients. Wrist joint injury can occur through a number of mechanisms — whether a slip in the kitchen, loss of balance on a neighborhood walk, or a fall while skiing or performing another physical activity. Older adult patients, in particular, experience wrist fractures often and tend to have more significant injuries.

Recovery from the knee cartilage graft procedure to repair the wrist includes casting for a defined period and then a removable orthosis, typically with a 6- to 8-week healing time after which the surgeon will approve use of the joint.

                                                          

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