Journal of Hand Surgery European - 2026-03-17 - Journal Article
Implant removal combined with total wrist denervation for painful intra-articular distal radial malunions: a prospective study.
Brenac C, Kachouh N, Walch A, Witters M, Mayoly A, de Villeneuve Bargemon JB
Topics
Key Takeaway
Implant removal combined with total wrist denervation reduced QuickDASH from 45.5 to 18.2 and VAS from 4.8 to 1.6 at 1 year in painful intra-articular distal radius malunions not amenable to osteotomy, while implant removal alone produced no significant improvement in either score.
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Summary
This single-center prospective study compared implant removal plus total wrist denervation versus implant removal alone in adults with painful intra-articular distal radius malunions not amenable to corrective osteotomy. The combined group achieved significant improvements in QuickDASH (45.5 to 18.2) and VAS (4.8 to 1.6) at 1 year, while the isolated group showed no significant change in either outcome. Grip strength also favored the combined group, with no between-group difference in ROM or complication rates.
Key Limitation
Non-randomized patient self-selection into treatment groups is the dominant limitation, as patients willing to undergo denervation may differ systematically in pain catastrophizing, expectations, or baseline function, making causal attribution of the outcome difference unreliable.
Original Abstract
INTRODUCTION
The main aim of this study was to compare functional, pain and clinical outcomes between patients who underwent implant removal combined with total wrist denervation and patients who underwent implant removal alone for painful intra-articular malunion of fracture of the distal radius that was not amenable to osteotomy.
METHODS
This single-centre, prospective study included adult patients with painful intra-articular distal radial malunion non-amenable to osteotomy between 2022 and 2025. Patients were offered either implant removal combined with total wrist denervation (combined group) or isolated implant removal (isolated group). The primary endpoint was a comparison between groups of the postoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and visual analogue scale (VAS) pain scores at 1 year. The secondary outcomes were the comparison of the postoperative range of motion (ROM), grip strength and complications.
RESULTS
Overall, 35 patients were included. In the combined group, the QuickDASH and VAS scores were significantly improved at 1 year from 45.5 (IQR: 38.6 to 50.0) to 18.2 (IQR: 13.6 to 27.3) and from 4.8 (SD 1.1) to 1.6 (SD 1.4), respectively. In the isolated group, no significant improvement in the QuickDASH nor in VAS was found. At 1 year, patients in the combined group had a significantly lower QuickDASH score, lower VAS scores and improved grip strength compared with patients in the isolated group. There was no difference between the groups regarding ROM and number of complications.
CONCLUSION
The addition of total wrist denervation during implant removal appears to offer substantial symptom relief and improved function in this population.
LEVEL OF EVIDENCE
III.