Abstract
Purpose This study aims to compare the outcomes and complications of our technique for nonspanning
total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning
technique.
Methods A retrospective review of charts was performed to identify patients who underwent
total wrist arthrodesis by the senior author (S.W.W.). We compared the outcomes of
15 cases of nonspanning wrist fusion with a 2.4/2.7 mm locking T plate to 11 cases
of spanning wrist fusion with a 2.7/3.5 mm locking compression plate. Minimum follow-up
was 3 months. Indications for fusion included rheumatoid arthritis, posttraumatic
arthritis, Kienböck's disease, primary osteoarthritis, juvenile inflammatory arthropathy,
psoriasis, brachial plexopathy, failed hemi or total wrist arthroplasty, failed four-corner
fusion, and failed proximal row carpectomy. The primary outcome was fusion. Secondary
outcomes included time to union, patient-rated wrist evaluation score, numerical rating
scale pain score, grip strength, and complications.
Results All the wrists got fused. There were no significant differences in objective and
subjective outcomes between cohorts. There were three complications (27%) in the spanning
group, including tendon rupture and peri-implant fracture at the third metacarpal.
This was compared with three complications (20%) in the nonspanning group, consisting
of hardware removal.
Discussion We achieved similar fusion rates employing both spanning and nonspanning total wrist
arthrodesis techniques, without necessitating carpometacarpal arthrodesis in the latter.
Complications associated with our method were comparably less severe than those reported
in the literature. We advocate nonspanning arthrodesis as an alternative method for
total wrist fusion with a high union rate and minimal risk of complications at the
carpometacarpal joint.
Level of Evidence Therapeutic level IV.
Keywords
total wrist arthrodesis - nonspanning - spanning - carpometacarpal - complications
