Failed wrist fusions fortunately are an infrequent problem for the hand surgeon to deal with. However, when it does occur, the surgeon may be faced with a multitude of problems relating to poor bone ...quality, bone loss, as well as copious scar tissue. Reconstructive options include autologous bone grafting, bone morphogenic protein, and external and/or internal bone stimulators. If the hardware has truly failed, the hardware may need to be changed out, but if there has been any windshield wiper effect to the bone, bony struts may have to be used. In the presence of previous infection, one can consider vascularized fibular bone graft. More recently, some wrist fusions that have failed to unite are being replaced with joint arthroplasty of the wrist. Ultimately, the surgeon has several options available in order to treat this clinical problem, which can leave the patient functionally impaired, secondary to the wrist deformity and pain. Ultimately, if satisfactory fusion or joint replacement can be obtained, improved but not total pain relief can be expected.
At operation, in conjunction with both thoracic surgery and orthopedic surgery services, his right sternoclavicular joint was isolated and reduced using open techniques. The joint was unstable, with ...a tendency to redislocate posteriorly. A high-speed burr was used to make holes in the medial portion of the clavicle and the manubrium. The joint was reduced and held in place by 2-gauge polydioxanone suture (PDS; Ethicon/Johnson & Johnson, Piscataway, NJ), reconstructing the sternoclavicular ligaments, capsule and rhomboid costoclavicular ligament. Intraoperative alignment and stability were excellent. The sternocleidomastoid and platysma muscles were repaired, and the incision was closed in standard fashion. A postoperative chest radiograph showed restoration of the normal anatomy of the thoracic cage and no evidence of pneumothorax. The sternoclavicular joint is a saddle-type synovial joint located between the medial end of the clavicle, the clavicular notch on the manubrium and the upper medial surface of the first costal cartilage (Fig. 2). It is the only bony attachment of the arm to the axial skeleton. The interarticular disc separates the joint into 2 synovial-lined spaces. The joint is stabilized on the anterior and posterior aspects by the anterior sternoclavicular ligament and the more robust posterior sternoclavicular ligament, respectively. The interclavicular ligament is a continuation of the deep cervical fascia and connects the medial heads of the 2 clavicles. The costoclavicular ligament, or rhomboid ligament, consists of anterior and posterior laminae connecting the clavicle to the first rib and first costal cartilage. All the ligaments must be torn for the joint to dislocate posteriorly.2
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