Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

Abstract

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. 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. 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. 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. Therapeutic level IV.

Locked Intramedullary Total Wrist Arthrodesis: A Report of Three Patients With Distal Screw Migration

“…CMC joint nonunion is reported in about 19% of the spanning plates in which CMC fusion is attempted [ 1 ]. This complication can be avoided using a “T” plate that stops short of the CMC joint and has demonstrated radiocarpal fusion rates similar to spanning plates [ 9 ]. However, even with a non-spanning “T” plate, the removal rate is 13% (two out of 15 patients) in one study [ 9 ].…”

“…This complication can be avoided using a “T” plate that stops short of the CMC joint and has demonstrated radiocarpal fusion rates similar to spanning plates [ 9 ]. However, even with a non-spanning “T” plate, the removal rate is 13% (two out of 15 patients) in one study [ 9 ]. A retrospective review of spanning plates used for radiocarpal fusion reported a reoperation rate of almost 20% for symptomatic hardware [ 10 ].…”

Results of the total wrist arthrodesis with contoured plate in a series of 41 wrists with median follow-up of 6 years

“…Another of the points still being debated in the performance of TWA concerns the number of joints to be fixed. The surgical technique we have used involves fusion of the radius, the carpal bones and the third metacarpal (3,17). As an alternative, Meads et al (4) also propose fusing the second carpometacarpal joint, excluding arthrodesis of joints other than the scaphoid-capitate and the lunate-capitate.…”

Total wrist arthrodesis with and without arthrodesis of the carpoMetacarpal joint (WAWWAM): study protocol

“…Continuous secondary outcomes will be analysed by ANOVA. This study is not powered to discriminate between treatments in terms of DASH and PRWE given the MCID (95% confidence interval) is 10 [5-15] and 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), respectively [14].…”

“…In a similar study, Berling disagreed, instead preferring to fuse the carpometacarpal joint to reduce the requirement for plate removal with a second operation [11]. Rancy compared a non-carpometacarpal spanning plate to a spanning plate with carpometacarpal joint fusion in a small retrospective series and reported similar results for both treatment groups [12]. Most recently, Hernekamp compared the Medartis APTUS© 2.5 TriLock Wrist Fusion Plate, which is a specially designed nonspanning plate that enables the carpometacarpal joint to be spared to the Depuy-Synthes© CMCJ spanning LCP wrist fusion plate without CMCJ arthrodesis, reporting similar results [4].…”