The Orthobullets Podcast CoinFlips | Hand | Progressive Wrist Pain in 70M
Oct 29, 2025
Asif Ilyas, an orthopedic hand surgeon specializing in wrist arthritis, along with experts Jason Nydick and Deana Mercer, dissect the complexities of managing progressive wrist pain in a 70-year-old man. They weigh the benefits of different surgical options like proximal row carpectomy versus four-corner fusion. Nonoperative approaches, denervation strategies, and nuances of wrist arthroplasty are explored. Insights on postoperative care and addressing potential complications like carpal loosening add depth to their engaging discussion.
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Fixation Technique For Carpal Components
- Use headless compression screws retrograde from the capitate into the lunate and a second screw triquetrum-to-hamate for carpal fixation.
- This preserves lunate cartilage and provides low-profile, cannulated fixation suited for fusion and implants.
Carpal Side Is The Failure Point
- Carpal-side fixation is the weak link in wrist arthroplasty because retained micro-motion at CMC joints prevents reliable bony ingrowth.
- That micro-motion, not the radial component, usually drives late loosening and failure.
Case: Distal-Axis Implant With Scaphoid Removal
- Michael performed a total wrist arthroplasty with a distal axis implant and minimal scaphoid resection to preserve capitate bone.
- He noted the design aimed to improve dart-throwing motion while retaining carpal bone stock.