A New Total Wrist Fusion Locking Plate for Patients with Small Hands or with Failed Partial Wrist Fusion: Preliminary Experience

Abstract

The author has designed a custom-made titanium plate for total wrist fusion for small-handed persons or patients with failed partial wrist fusions. From May 2011 to April 2013, this plate was used on 13 wrists, 5 of them with a minimum follow-up of 1 year. This implant is downsized compared with the standard wrist fusion plate: lower in profile, shorter in length, and narrower than the standard one. It is fixed to the radius by means of 2.7-mm screws and to the capitate and third metacarpal with 2.4-mm screws. In the curved plate all the screws are locked to the plate with a predetermined coaxial angle. The plate has a curvature to fit the dorsum of the carpus; it is 10° dorsally extended and has undercuts on the contact areas at the radius and third metacarpal dorsal surface. The indication for this implant is a short-statured patient for whom the standard plate is too large and bulky; a failed partial wrist fusion or proximal row carpectomy, for which a shorter plate is needed because only one articulation should be fused (midcarpal or radiocapitate joint); or both. The five wrists (two primary fusions and three failed radioscapholunate [RSL] fusions) healed between 11 and 14 weeks. No plate loosening was observed, and none of the patients felt painful prominence to the distal end of the plate on the dorsum of the hand.

Keywords

wrist - total wrist fusion - partial wrist fusion - locking plate

Note

Presented as a preliminary technical report at the 27th Annual Meeting of the International Wrist Investigator Workshop (IWIW). Las Vegas (NV), USA, September 7, 2011.

• References

• 1 Houshian S, Schrøder HA. Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases. J Hand Surg Br 2001; 26 (4) 355-359
• 2 Kalb K, Prommersberger KJ. Total wrist fusion using the AO wrist fusion plate [in German]. Oper Orthop Traumatol 2009; 21 (4-5) 498-509
• 3 Solem H, Berg NJ, Finsen V. Long term results of arthrodesis of the wrist: a 6-15 year follow up of 35 patients. Scand J Plast Reconstr Surg Hand Surg 2006; 40 (3) 175-178
• 4 Cavaliere CM, Chung KC. A systematic review of total wrist arthroplasty compared with total wrist arthrodesis for rheumatoid arthritis. Plast Reconstr Surg 2008; 122 (3) 813-825
• 5 Nagy L, Büchler U. AO-wrist arthrodesis: with and without arthrodesis of the third carpometacarpal joint. J Hand Surg Am 2002; 27 (6) 940-947
• 6 González del Pino J. Total wrist fusion in rheumatoid arthritis. A new perspective on plate fixation. In: Herren DB, Nagy L, Campbell DA, , eds. Osteosynthesis in the Hand. Basel, Switzerland: Karger; 2008: 99-106
• 7 Biswas D, Wysocki RW, Cohen MS, Fernandez JJ. Radioscapholunate arthrodesis with compression screws and local autograft. J Hand Surg Am 2013; 38 (4) 788-794
• 8 Fernández DL, Capo JT, González E. Corrective osteotomy for symptomatic increased ulnar tilt of the distal end of the radius. J Hand Surg Am 2001; 26 (4) 722-732
• 9 Orbay J, Feliciano R, Orbay C. Locked intramedullary total wrist arthrodesis. J Wrist Surg 2012; 1 (2) 179-184
• 10 van Lenthe GH, Mueller TL, Wirth AJ, Müller R. Quantification of bone structural parameters and mechanical competence at the distal radius. J Orthop Trauma 2008; ; 22 (8, Suppl): S66-S72
• 11 Ruchelsman DE, Mudgal CS, Jupiter JB. The role of locking technology in the hand. Hand Clin 2010; 26 (3) 307-319 , v
• 12 Green DP, Henderson CJ. Modified AO arthrodesis of the wrist (with proximal row carpectomy). J Hand Surg Am 2013; 38 (2) 388-391