An anatomical basis for the management of complex wrist injuries.

Abstract

The work described in this thesis was carried out by the author to address perceived deficiencies in the knowledge of wrist anatomy, imaging and surgical management principles. The thesis encompasses studies of normal anatomy, imaging of the normal and abnormal wrist, the classification of complex carpal injuries, and the potential for further research. At the commencement of this work, areas of deficiency were identified and were addressed. These included (i) the morphology of the normal wrist, (ii) imaging techniques of morphological variants, (iii) morphological association with midcarpal osteoarthritis, and (iv) the clinical application of classification systems for the management of complex carpal injuries. To address these deficiencies, a combined radiographic and MRI study was undertaken to determine the best method for identification of the various morphological variations of the articular surfaces at the midcarpal joint, using non-invasive imaging techniques. In addition, a clear standard for accurate recognition of these variants using different imaging techniques was established. An inter-observer reliability study was undertaken to establish the reproducibility of the techniques, and to compare the results with previously reported data. A correlation analysis of the various carpal morphologies can now be undertaken. If a clear pattern of wrist morphology exists, the differences in carpal kinematics and pathomechanics related to wrist morphology can be more easily investigated. In addition, it is now possible to use non-invasive methods of investigation to examine the relationship(s) between various wrist morphologies and differences in ligament composition and distribution, different carpal kinematics and pathomechanics, and different incidences and predispositions to various carpal pathologies. Further research is needed to address these questions. In summary, the work described in this thesis increases the knowledge of normal wrist morphology and imaging. It further advances the knowledge of pathomechanics related to wrist morphology and presents a new understanding in regard to the principles of the management of complex carpal injuries.