Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

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

Note

This study was approved by the Hospital for Special Surgery's Institutional Review Board (#2015–396) on November 24, 2015.

• References

• 1 Nagy L, Büchler U. AO-wrist arthrodesis: with and without arthrodesis of the third carpometacarpal joint. J Hand Surg Am 2002; 27 (06) 940-947
• 2 Weiss AP, Hastings II H. Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application. J Hand Surg Am 1995; 20 (01) 50-56
• 3 Berling SE, Kiefhaber TR, Stern PJ. Hardware-related complications following radiocarpal arthrodesis using a dorsal plate. J Wrist Surg 2015; 4 (01) 56-60
• 4 Bolano LE, Green DP. Wrist arthrodesis in post-traumatic arthritis: a comparison of two methods. J Hand Surg Am 1993; 18 (05) 786-791
• 5 Hartigan BJ, Nagle DJ, Foley MJ. Wrist arthrodesis with excision of the proximal carpal bones using the Ao/ASIF wrist fusion plate and local bone graft. J Hand Surg [Br] 2001; 26 (03) 247-251
• 6 Hastings II H, Weiss A-PC, Quenzer D, Wiedeman GP, Hanington KR, Strickland JW. Arthrodesis of the wrist for post-traumatic disorders. J Bone Joint Surg Am 1996; 78 (06) 897-902
• 7 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 (04) 355-359
• 8 O'Bierne J, Boyer MI, Axelrod TS. Wrist arthrodesis using a dynamic compression plate. J Bone Joint Surg Br 1995; 77 (05) 700-704
• 9 Rayan GM. Wrist arthrodesis. J Hand Surg Am 1986; 11 (03) 356-364
• 10 Urbaniak JR. Arthrodesis of the hand and wrist. In: Evarts CM. , ed. Surgery of the Musculoskeletal System. New York, NY: Churchill Livingstone; 1983: 2371-2386
• 11 Bracey DJ, McMurtry RY, Walton D. Arthrodesis in the rheumatoid hand using the AO technique. Orthop Rev 1980; 9: 65-69
• 12 Onuma K, Shintani R, Fujimaki H. , et al. Total wrist arthrodesis with wrist fusion rod in patients with rheumatoid arthritis. Eklem Hastalik Cerrahisi 2015; 26 (01) 41-48
• 13 Stanley J. Arthroplasty and arthrodesis of the wrist. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH. , eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier; 2010: 429-463
• 14 Hayden RJ, Jebson PJ. Wrist arthrodesis. Hand Clin 2005; 21 (04) 631-640
• 15 Pham TT, Lenoir H, Coulet B, Wargny M, Lazerges C, Chammas M. Proximal row carpectomy in total arthrodesis of the rheumatoid wrist. Orthop Traumatol Surg Res 2015; 101 (08) 919-922
• 16 Rauhaniemi J, Tiusanen H, Sipola E. Total wrist fusion: a study of 115 patients. J Hand Surg [Br] 2005; 30 (02) 217-219
• 17 Pardini Jr AG, Pádua Gonçalves RF, Freitas AD, Chaves AB. Wrist arthrodesis with minimal internal fixation preserving the carpometacarpal joints. Rev Bras Ortop 2015; 45 (01) 67-71
• 18 Sagerman SD, Palmer AK. Wrist arthrodesis using a dynamic compression plate. J Hand Surg [Br] 1996; 21 (04) 437-441
• 19 Joseph RB, Linscheid RL, Dobyns JH, Bryan RS. Chronic sprains of the carpometacarpal joints. J Hand Surg Am 1981; 6 (02) 172-180
• 20 Passin S, Pochlatko N, Ebi D, Spiegel A, Sauerbier M. Biomechanical testing of a new total wrist arthrodesis plate [in German]. Handchir Mikrochir Plast Chir 2015; 47 (01) 32-37
• 21 Zachary SV, Stern PJ. Complications following AO/ASIF wrist arthrodesis. J Hand Surg Am 1995; 20 (02) 339-344
• 22 del Pino JG. A new total wrist fusion locking plate for patients with small hands or with failed partial wrist fusion: preliminary experience. J Wrist Surg 2014; 3 (02) 148-153
• 23 Terzis JK, Barmpitsioti A. Wrist fusion in posttraumatic brachial plexus palsy. Plast Reconstr Surg 2009; 124 (06) 2027-2039
• 24 Wright CS, McMurtry RY. AO arthrodesis in the hand. J Hand Surg Am 1983; 8 (06) 932-935
• 25 Wang T, Chan CM, Yu F, Li Y, Niu X. Does wrist arthrodesis with structural iliac crest bone graft after wide resection of distal radius giant cell tumor result in satisfactory function and local control?. Clin Orthop Relat Res 2017; 475 (03) 767-775
• 26 Adams BD, Kleinhenz BP, Guan JJ. Wrist arthrodesis for failed total wrist arthroplasty. J Hand Surg Am 2016; 41 (06) 673-679
• 27 Giuffre JL, Bishop AT, Spinner RJ, Kircher MF, Shin AY. Wrist, first carpometacarpal joint, and thumb interphalangeal joint arthrodesis in patients with brachial plexus injuries. J Hand Surg Am 2012; 37 (12) 2557-63.e1
• 28 Clarkson PW, Sandford K, Phillips AE. , et al. Functional results following vascularized versus nonvascularized bone grafts for wrist arthrodesis following excision of giant cell tumors. J Hand Surg Am 2013; 38 (05) 935-940.e1
• 29 Larsson SE. Compression arthrodesis of the wrist. A consecutive series of 23 cases. Clin Orthop Relat Res 1974; (99) 146-153
• 30 Abbott LC, Saunders JBDM, Bost FC. Arthrodesis of the wrist with the use of grafts of cancellous bone. J Bone Joint Surg Am 1942; 24: 883-898