Wrist arthrodesis with afixed-angle, "low-profile" fusion plate without carpometacarpal joint fixation

Abstract

Total wrist arthrodesis to improve functional use of the hand by reducing pain and increasing grip strength. Painful destruction of the radio- and midcarpal joints. Analgesia and satisfactory hand function after motion-preserving surgical or conservative treatment. Chronic joint infection. Posterior approach to the wrist. Removal of articular surfaces destroyed all the way down to cancellous bone. Filling of defects with cancellous bone graft taken from distal radius or iliac crest. Osteosynthesis with fixed-angle wrist fusion plate without carpometacarpal (CMC) III joint fixation. Below-elbow cast for 2weeks. Immediate active motion fingers exercises. X‑ray control 6weeks postoperatively. Gradual increase of normal hand use in daily life after bony consolidation. Total wrist arthrodesis was performed using afixed-angle fusion plate without CMCIII joint fixation in 28patients (21men, 7women). Afollow-up of 14/28patients was performed at amean of 21 (3-39) months postoperatively. Grip strength improved from 14 (0-38) kg preoperatively to 22 (12-40) kg postoperatively. The average postoperative DASH score was 40 (6-72) points. Pain measured with the VAS scale (0-10) improved from an average of 7 (3-10) points preoperatively to 2 (0-6) points postoperatively. Overall, 13/14patientswere satisfied with the treatment; 26/28patients achieved primary bony consolidation. Postoperative complications found in 9 of 28patients: 2 nonunion, pain in the CMCII (n= 3) or III (n= 1) joints, 2 screw breakage, 1 postoperative bleeding and 1 infection. Both cases of nonunion healed after plate removal, re-osteosynthesis with astraight wrist arthrodesis plate, bridging the CMCIII joint, and abone graft from the iliac crest. All patients with CMCII joint pain were pain-free after removal of the protruding screw. One patient had chronic pain in the CMCIII joint despite plate removal. In the 2cases with screw breakage, no issues caused. In one patient, after primary bony consolidation, removal of the plate was performed for extensor tenolysis and not as aresult of the broken screw. In the second patient, removal of the plate after primary bony consolidation was unnecessary as the patient was pain-free in the area of the broken screw, yet aprotruding screw in the CMCII joint cavity was removed.