March 9, 2007

(SACRAMENTO, Calif.) — Physicians treating patients suffering from wrist instability, the most common type of wrist injury, have many options for repairing the torn ligaments that result from falls and other trauma. But what orthopaedic surgeons throughout the country don't know is which surgical technique best helps patients avoid the debilitating arthritis that invariably results from this painful condition.

To that end, Robert Szabo, professor of orthopaedic surgery at UC Davis Health System, conducted a follow-up study of surgical technique he developed over a decade ago to treat wrist instability. The poster presentation of that study and its results recently won top honors at the annual American Academy of Orthopaedic Surgeons  meeting held in San Diego in February. The research was presented by the poster's first author, second-year medical student Varun Gajendran.

Szabo, Gajendran and their co-author, orthopedic fellow Brett Peterson, won first place in the “Hand/Wrist” category for poster presentations. The academy selected a total of 525 papers and 541 posters from the 4,069 abstracts that were submitted. Top honors were given to one poster in each of 12 categories, with one over-all winner for poster presentations.

Gajendran led the group's effort to contact former patients of Szabo's whom he had treated for wrist instability, also called chronic scapholunate dissociation. Most patients with the condition experience painful popping and clicking of the wrist. Although the initial injury is caused by torn ligaments, degeneration of the entire wrist results over time.

“It's like when one tire of a car is unbalanced,” Szabo explained. “The other tires wear out prematurely.”

As part of the follow up, the patients' wrist X-rays, range of motion, grip strength and responses to standard questionnaires in the field were used to evaluate their outcomes. The group found that, although patients reported high levels of satisfaction, the X-rays and range of motion measurements revealed that the reconstruction did not prevent the development of osteoarthritis, or the deterioration of cartilage lining the joints and new bone formation beneath the cartilage.

“The best thing about this procedure overall was that the patients were quite satisfied with the results,” Gajendran said. “While they did lose their range of motion over time, they also showed an unexpected increase in grip strength.”

Although prevention of arthritis was not a predictable outcome, Szabo said the work will serve to better screen patients for the procedure and inform patients considering surgical and non-surgical options.

“We're still looking for the best way to fix this,” Szabo said.

Szabo said he believes research experience, though not a requirement for medical students, is invaluable in training the next generation of physicians. He tries to include interested medical students in research projects whenever he can.

“With patient-oriented research, you learn the long-term consequences of reconstructive surgery — the impact on people's lives — before you pick up a scalpel,” he said.