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Early Experience With Locked Intramedullary Wrist Arthrodesis. J Hand Surg Am 2021 Jul;46(7):620.e1-620.e6

Date

01/25/2021

Pubmed ID

33485715

DOI

10.1016/j.jhsa.2020.11.015

Scopus ID

2-s2.0-85099666428 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

PURPOSE: The most common method of total wrist arthrodesis is dorsal compression plating, which can require revision for soft tissue or tendon irritation. A locked intramedullary system was developed to reduce this complication. The goal of this study was to investigate the complication rate of total wrist arthrodesis using this system in our center.

METHODS: A retrospective chart review of all patients undergoing intramedullary wrist arthrodesis from January 2016 to February 2018 was performed.

RESULTS: Nine wrist arthrodeses were performed with locked intramedullary wrist fusion in 5 women and 4 men. The indications for fusion included posttraumatic arthritis in 7 and inflammatory arthritis in 2. Two patients underwent primary arthrodesis and 7 had revision from prior partial wrist fusions. Local bone graft at the radiocarpal joint was used in all cases. The mean follow-up was 27 weeks. Radiocarpal fusion was achieved in 8 patients after the initial procedure and in the ninth patient after revision. There were 6 complications in 4 patients with revision reoperation required in 3. The complications were metacarpal locking screw migration in 3, metacarpal fracture in 1, radiocarpal nonunion in 1, and symptomatic middle finger carpometacarpal nonunion in 1. The revision surgeries include distal screw removal in 1, distal screw removal with replacement in 1, and bone grafting in the radiocarpal nonunion.

CONCLUSIONS: Use of the locked intramedullary wrist fusion system yields high fusion rates. However, based on the high complication rate, particularly from distal screw migration, and the high revision rate in this series, we recommend caution with the use of this system.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Author List

Walker MR, Hoben GM, Best CM, Daley RA

Author

Gwendolyn M B Hoben MD Assistant Professor in the Plastic Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Arthritis
Arthrodesis
Female
Humans
Male
Retrospective Studies
Wrist
Wrist Joint